Preamble

The House met at half-past Two o'clock

PRAYERS

[Mr. SPEAKER in the Chair]

PRIVATE BUSINESS

KILLINGHOLME GENERATING STATIONS (ANCILLARY POWERS) BILL [Lords]

Order for Third Reading read.

To be read the Third time tomorrow.

LONDON UNDERGROUND (SAFETY MEASURES) BILL [Lords]

Order for Second Reading read.

To be read a Second time tomorrow.

LONDON UNDERGROUND BILLS

Ordered,
That it be an Instruction to the Committee on the London Underground Bill and the London Underground (No. 2) Bill, that they have the power, if they think fit, to consolidate the said Bills or any part or parts thereof into one Bill.—[Mr. Neubert.]

Oral Answers to Questions — SCOTLAND

Local Government Finance

Sir Russell Johnston: To ask the Secretary of State for Scotland if he will make a further statement on the reform of local government finance.

The Secretary of State for Scotland (Mr. Ian Lang): I announced our outline proposals on the reform of local government finance to the House on 21 March. We shall be issuing a consultation paper shortly.

Sir Russell Johnston: Will the Secretary of State tell us his thoughts on who is to meet the cost of care in the community? That is something that the Secretary of State for the Environment did not mention in his statement on 21 March. Is the right hon. Gentleman aware that there is a good deal of concern among local authorities about how the mentally handicapped and mentally ill patients coming out of institutions are to be cared for and paid for? I should like to know the position.

Mr. Lang: The hon. Gentleman has identified a subject of great importance, to which the Government have given a great deal of attention. He will be aware of our developing plans in that area. The consultation paper that is to be published and the statement that has been made are primarily concerned with the way in which local government finance is collected and the contributions made to it by local residents.

Mr. Tom Clarke: Will the Secretary of State deal with the specific question asked by the hon. Member for Inverness, Nairn and Lochaber (Sir R. Johnston)? Is the right hon. Gentleman aware that the matter is of supreme importance, especially to regional and island authorities that have to deal with the problems of mentally ill and mentally handicapped people and their carers? Those authorities' budgets are being cut and they want to hear more from the Secretary of State today than they have heard to date.

Mr. Lang: I urge the hon. Gentleman to table a question on that subject. The question that I am answering is about the Government's consultation paper and the statement on the reform of local government finance. Our record on the funding of community care is second to none and substantial improvements in the handling of that matter are under way.

Sir Hector Monro: Does my right hon. Friend agree that finance and the structure of local government must go hand in hand? Does he accept that in the review of the structure of local government, the issues relevant to Strathclyde will be very different from those relevant to Dumfries and Galloway? I hope that he will be flexible in his arrangements so that we can find the best method for each region in Scotland.

Mr. Lang: I am grateful to my hon. Friend, with whom I agree that the funding and the structure of local government should be considered together. The Government propose to consult widely on possible developments for the structure of local government. When we bring forward proposals in due course, we shall take careful account of the varied and diverse nature of Scotland, and that will be reflected in the structure on which we decide.

Mr. Dewar: On the specific subject of local government finance, will the Secretary of State confirm that he now believes that a local government tax, essentially based on property and the rate poundage and paid by householders, is preferable to the poll tax? Can he explain why he greeted that very same proposal, when it was made by the Labour party, with scorn and contempt? He now appears to be prepared to endorse it.

Mr. Lang: The hon. Gentleman is asking me to anticipate the publication of our consultation paper. He is not going to draw me on that, other than for me to repeat that in our statement we made it clear that we are proposing a new local tax. It will be a single tax with a property and personal element. I think that he will find that it is rather different from the Labour party's proposals. At the next election, the electorate will have a choice—our new, fair, local tax or a return to rates under Labour.

Health Boards

Mrs. Irene Adams: To ask the Secretary of State for Scotland if he will make a statement on the criteria used for the appointment of non-executive members of Scottish health boards.

The Minister of State, Scottish Office (Mr. Michael Forsyth): The criteria for the appointment of non-executive members of Scottish health boards were that


they should have the qualities and abilities necessary to make an effective contribution, individually and collectively, to the boards' new role.

Mrs. Adams: Will the Minister admit that there is only one criterion for selection to health boards in Scotland: membership of or affiliation to the Conservative party? Does he realise that Renfrew district, the biggest centre of population in the Argyll and Clyde area, does not have a single representative on that area's health board? Is he telling us that there are no able Conservatives in that area? If so, I agree with him.

Mr. Forsyth: I suggest that the hon. Lady has a word with her hon. Friend the Member for Cunninghame, South (Mr. Lambie), who suggested two members of health boards who were appointed by my right hon. Friend. I do not think that the criterion applied in their case was the one that the hon. Lady has in mind.
The hon. Lady is wrong to say that no one from Paisley is on the health board that covers her constituency. If she does her homework she will find that Mr. Bremner comes from Paisley.

Mr. Eadie: Does not the Minister realise that that answer is most unsatisfactory and does not fit the facts? The criteria for appointment of members to health boards are that people should be supporters of the Conservative party or card-carrying members of it. Does he not realise that his reply to the question asked by my hon. Friend the Member for Paisley, North (Mrs. Adams) was disgraceful?

Mr. Forsyth: No, I do not. The hon. Gentleman did not listen to my answer; I refer him, too, to the hon. Member for Cunninghame, South. The criteria that have been applied are to establish whether people have the necessary qualities. Many members of health boards who are not members of the Conservative party and who work hard on behalf of the health service will take considerable offence at questions of the kind asked by the hon. Gentleman.

Mr. Galbraith: Why is it, then, that of the 15 chairmen of health boards, 11 represent either Conservative or business interests, two are from the National Farmers Union and only two do not fall into either category? Are not my hon. Friends correct to say that the only criterion for becoming a chairman of a health board or a non-executive member is to be a member of the Conservative party or a supporter of it?

Mr. Forsyth: I dare say that the right hon. and learned Member for Monklands, East (Mr. Smith) will be astonished to hear the hon. Gentleman assuming that everyone with a business background is a supporter of the Conservative party—although to judge from what the Labour party produced yesterday I am sure that that will shortly be the case.

Several Hon. Members: rose—

Mr. Speaker: Order. As the hon. Member for Cunninghame, South (Mr. Lambie) has been mentioned, I call him.

Mr. Lambie: I congratulate the hon. Gentleman on accepting the two nominations that I put forward on behalf of the Labour party and the trade union movement in Ayrshire. Those two representatives, Angela Dunbar

and Joe Cahill, have served the Ayrshire and Arran health board well in the past and I am grateful that they have been re-elected.

Mr. Forsyth: I wish to make it absolutely clear that the reason why those two people were appointed had nothing to do with their support for or membership of the Labour party; it was simply because of their record of service on the board and the contribution that they can make to it.

Scottish Parliament

Mr. Canavan: To ask the Secretary of State for Scotland if he will arrange to meet representatives of the Scottish Constitutional Convention to discuss their proposals for a Scottish Parliament.

Mr. Lang: A meeting with the Scottish Constitutional Convention would serve no useful purpose since its proposals, which I have considered carefully, are irrelevant to the basic concerns of the Scottish people and unlikely to be of benefit to Scotland.

Mr. Canavan: Why is it that the Secretary of State for Wales is prepared to discuss the possibility of a Welsh Assembly and the Secretary of State for Northern Ireland is prepared to discuss the possibility of a Northern Ireland Parliament, yet the Secretary of State for Scotland refuses even to discuss with the convention its proposals for a Scottish Parliament? Does he not realise that unless he responds positively to the overwhelming wishes of the people of Scotland before the next general election, he may, after that election, join the likes of Mr. Graeme Souness looking for another job in England?

Mr. Lang: I am certain that my right hon. Friend the Secretary of State for Wales would not contemplate a tax-raising Welsh assembly any more than I would contemplate a tax-raising Scottish assembly. I draw the hon. Gentleman's attention to the Scottish division of the Institute of Directors whose views have been characterised as:
If such an assembly were set up with these powers, we would move company headquarters out of Scotland.

Sir Nicholas Fairbairn: May I congratulate my right hon. Friend on having nothing to do with the Scottish Constitutional Convention? It is organised by church men and freaks who, if they had paid some attention to their calling, might not have empty churches. If Scotland were treated to the sort of things that they want, they would empty our nation of its people as they have emptied their churches of congregations.

Mr. Lang: My hon. and learned Friend makes his point in his inimitable way. The Scottish Constitutional Convention is certainly a self-appointed and self-designated body and has been described as the Labour party at prayer. Certainly, the Liberal party went along for the ride and ended up being taken for a ride. The Scottish Constitutional Convention does not speak for Scotland and has produced nothing of any relevance to Scotland's future.

Mr. Salmond: If the constitutional convention were prepared to return to its founding document, "A claim of right" and put the matter of constitutional change directly to the Scottish people in a referendum, would the Secretary of State have the guts to put his proposals to the


people in the referendum? What is the argument against having a referendum putting the choice of independence, devolution and the status quo, and letting the Scottish people decide?

Mr. Lang: At least I have in common with the hon. Gentleman that neither he nor I have been interested in taking part in the Scottish Constitutional Convention—I, because I believe that it goes too far in nationalism, and he, presumably, because he believes that it does not go far enough. It is not a representative body, it has produced no realistic proposals and it has addressed none of the fundamental issues affecting the constitutional future of Scotland.

Mr. Bill Walker: Does my right hon. Friend agree that the Scottish Constitutional Convention spent months talking, yet failed to address the Goschen Barnett formula, the West Lothian question and the number of Scottish Members of this Parliament? Because of that, any proposals from that source would have no hope whatever of getting through Parliament to be implemented and, therefore, they are fraudulent and flawed.

Mr. Lang: My hon. Friend is absolutely right. All the proposals emerging from the Opposition for tax-raising Scottish assemblies would be immensely damaging to the future of Scotland. They would drive away inward investment, destroy investment at home, damage the future prospects of economic growth and destroy jobs.

Local Government Finance

Mr. Ingram: To ask the Secretary of State for Scotland when he last met COSLA to discuss the future of local government finance in Scotland; and if he will make a statement.

Mr. Norman Hogg: To ask the Secretary of State for Scotland when he next expects to meet the Convention of Scotland Local Authorities to discuss the poll tax

Mr. Lang: My hon. Friend the Minister for Industry and Local Government and I met the convention on 8 April to discuss a number of local government finance issues, including the community charge.
I hope to meet the convention again once it is in a position to respond to our consultation paper on the proposed new local taxation system.

Mr. Ingram: Will the Secretary of State tell the House when he changed his mind, and what or who made him change his mind about the poll tax?

Mr. Lang: The hon. Gentleman will be well aware that the Government have been considering the funding of local government finance for a long time. We have recognised that the community charge is not operating effectively and has not gained general acceptance in Scotland. Therefore, after a relatively short period of time and after very thorough and careful scrutiny of the options, we have decided on a new local tax which has been announced to the House as to its fundamentals and on which a consultation paper will appear shortly.

Mr. Norman Hogg: Given that there is more joy in heaven over one sinner that repents, can we now expect the

Secretary of State for Scotland to evangelise Scotland for a property tax, and will he bring Missionary zeal to that work?

Mr. Lang: The hon. Gentleman must wait and see what our new tax is all about. The Opposition are worried not that our new proposals will not work but that they will work.

Mr. Buchanan-Smith: While I believe that it would be quite wrong for the Secretary of State to speculate in any way on what announcements may be made in the next week or so, does he accept that if we return to a form of property taxation, it is very important that the basis of valuation and revaluation of property is the same north and south of the border?

Mr. Lang: My right hon. Friend makes an important point about valuation and revaluation. It is an issue which we have considered with great care and I hope that he will not be disappointed when the consultation paper is published.

Mr. Maxton: In view of the commitment to the poll tax shown by the hon. Members for Stirling (Mr. Forsyth) and for Eastwood (Mr. Stewart) and of their long-standing opposition to any form of property tax, can the Secretary of State tell us whether the two of them will still be Ministers following the announcement next week? Can the Secretary of State guarantee that when he publishes the consultative document next week it will contain figures that I can take to my constituents to tell them exactly how much they will pay under the new tax? Or shall we have to print posters next week to put up around Scotland saying, "Ian, where's your figures?"

Mr. Lang: I am sure that my hon. Friends the Members for Stirling (Mr. Forsyth) and for Eastwood (Mr. Stewart) will be in the Government, not only next week but next year and the year after and the year after that. [Interruption.] And my hon. Friend the Member for Edinburgh, West (Lord James Douglas-Hamilton).
The hon. Gentleman asked about figures, but he should consider those relating to the number of different varieties of policies suggested by the Opposition. At the last count there were 67—that makes H. J. Heinz look like a one-product company.

Higher Education

Mr. John Marshall: To ask the Secretary of State for Scotland if he will make a statement about the number of students in higher education in Scotland.

Mr. Michael Forsyth: The numbers of students in full-time higher education have increased by about one third to 90,000 since the Government took office. Part-time students have also increased by about one fifth.

Mr. Marshall: I thank my hon. Friend for that answer, which is good news for the people of Scotland and especially for the individuals involved. Does he agree that it demonstrates the Government's commitment to the cause of higher education and to the creation of an opportunity society?

Mr. Forsyth: Yes, indeed. When the Government took office, about one in six school leavers went on to higher


education. Today the figure is about one in four and by the end of our next decade in office, the figure will be one in three.

Mr. Ron Brown: I am sure that the Minister knows, but is forgetting, that many rejects from the public school system in England are given certain rights to come to Scotland—and especially to Edinburgh university—at the expense of ordinary, working-class individuals. That was exposed recently. What is he doing to ensure that there is equality of opportunity in Scotland for both English and Scottish working-class individuals and for youngsters who have every right to higher education? The Minister must know about that problem because it was highlighted in The Scotsman some months ago and he clearly reads that newspaper.

Mr. Forsyth: If the hon. Gentleman says that it appeared in The Scotsman, I suppose that it must be so. However, if he considers our record he will find that participation in higher education in Scotland has already gone beyond the target set for England by the end of the century. We have a participation rate of about 25 per cent. That is an excellent record, but we are not complacent about it. As I said, we have set ourselves high targets and the decisions taken on higher and further education will enable us to achieve our objectives.

Primary Schools

Mr. Knox: To ask the Secretary of State for Scotland how much was spent per pupil in primary schools in Scotland in the most recent year for which figures are available; and what was the comparable figure in 1978–79, at constant prices.

Mr. Michael Forsyth: Current expenditure per pupil in 1989–90 has increased by 50 per cent. over and above the rate of inflation since 1979 in primary schools. The latest figure is £1,385 before taking account of the costs of local authority administration, school meals and transport, which are substantial.

Mr. Knox: Can my hon. Friend say how those figures square with claims that there have been cuts in primary education in Scotland during the past 12 years or even claims that there has been underfunding of primary school education?

Mr. Forsyth: The Opposition make those claims from time to time. The figures show that expenditure per pupil has increased by one half over and above price rises. Any talk of cuts is simply nonsense. The effects of that expenditure can be seen in the improved performance in our schools.

Dr. Reid: Will the Minister make similar comparisons of the expenditure per pupil in primary schools in 1978–79 and now on party political propaganda, such as that used to support the school boards and now to promote national testing? Nothing was squandered from the education budget on such propaganda 10 or II years ago, but now hundreds of thousands of pounds are spent ramming down the throats of pupils and parents in Scotland propaganda to support a system for which they have no sympathy—national testing. Would not it better to spend that money on much-needed learning support so that pupils benefit, rather than the Conservative party?

Mr. Forsyth: We have already made a commitment to find a way of channelling further resources into learning support. The hon. Gentleman mentioned school boards and party political propaganda. Strathclyde region spent more to promote school boards than the Government campaign overall. This aspect ceased to be a matter of difference between the parties only when the Labour party changed its position on school boards.
The Opposition should get their act together. Only a few months ago they criticised the Government for not having provided enough information to parents about national testing. We did not embark on our programme of leaflets and advertising until we had been requested by parents, organisations and the Opposition to do so.

Volunteer Fire Brigades

Mr. Beith: To ask the Secretary of State for Scotland how many volunteer fire brigades are operated by local authorities in Scotland.

The Parliamentary Under-Secretary of State for Scotland (Lord James Douglas-Hamilton): There are 140 volunteer fire units in Scotland, mostly in highland and islands areas.

Mr. Beith: Does the Minister agree that volunteer fire units provide a vital service to island communities and remote areas? Is there any danger that substantial numbers of those units will be disbanded because of difficulties in applying the health and safety regulations in full'? Is the hon. Gentleman aware that that was the reason given by Labour-controlled Northumberland county council for disbanding the Holy Island fire brigade, one of the few in England? Will that problem arise in Scotland or will the hon. Gentleman find a solution to it?

Lord James Douglas-Hamilton: I agree that volunteer fire brigades have performed an extremely valuable role in Scotland. Volunteer units can render initial cover in advance of the arrival of full-time or retained fire-fighting crews. I envisage volunteer units in Scotland remaining an important part of the Scottish fire service, because volunteer units give confidence to people in remote areas and the islands in a way that is effective and provides value for money.
It is for each fire authority to consider what needs to be done within its area according to the Control of Substances Hazardous to Health Regulations 1988. I suggest that the hon. Gentleman follows up this matter with the responsible home affairs Minister. I understand that the hon. Gentleman will have a meeting with him shortly.

Prosecutions

Mr. Nigel Griffiths: To ask the Secretary of State for Scotland if he will take steps to reduce delays in bringing prosecutions against people charged with offences.

Lord James Douglas-Hamilton: My noble and learned Friend the Lord Advocate sets targets for the average time that should elapse between receipt of a police report by a procurator fiscal and the service of a complaint on an accused. Latest figures indicate that the overwhelming majority of procurator fiscal offices meet these targets.

Mr. Griffiths: Are not the targets woefully inadequate? Over the past year, people pleading and going to trial faced delays of up to 26 weeks in Scotland. That does nothing to help the morale of the police force, trading standards officers and others who enforce the law. Are not the Government's inaction and the lack of will to tackle these serious delays the reasons why we have a crime wave?

Lord James Douglas-Hamilton: Steps have been and are being taken to speed up cases coming to court. A standard style of police report has been introduced which should reduce delays. A joint working group comprising the Crown Office and chief constables recommended that the fiscal should have a report within, at the latest, 28 days of the accused being cautioned and charged by the police. It is important that, both in sheriff and district courts, the target in non-custody cases between pleading and trial is 10 to 14 weeks. The number of permanent and temporary sheriffs in Scotland has been increased by 70 since 1983 and that, too, is important. We are also introducing more and more computer technology into the courts.

Mr. Michael J. Martin: God help us!

Lord James Douglas-Hamilton: God help the criminals, because we shall have a more efficient system to deal with them. The fingerprint technology will bring many more of them to trial. A number of reviews are taking place and I assure the hon. Gentleman that we shall follow them through with vigour.

Dr. Godman: May I remind the Minister that delays in bringing prosecutions in cases involving allegations of child abuse or sexual abuse can be extremely distressing, affecting not only those charged with such offences but, more importantly, the victims of such crimes? Surely the utmost speed must be impressed upon those with authority in relation to such dreadful cases. The children involved must be treated humanely and compassionately and not subjected to unnecessary delays.

Lord James Douglas-Hamilton: My hon. Friend the Minister of State will be speaking to social workers on that subject on Friday. I shall draw the hon. Gentleman's remarks to the attention of the Lord Advocate, as I appreciate the hon. Gentleman's concern on this matter.

Sir Nicholas Fairbairn: May I remind Opposition Members that Scotland is unique in the world —

Mr. Speaker: Order. The hon. and learned Gentleman should seek to remind the Minister or, better still ask a question.

Sir Nicholas Fairbairn: I remind the Minister that Scotland is unique in the European Community because we have a system of justice that requires prosecution within statutory times and we achieve those statutory times with regularity and excellence. When I was a Law Officer, at a meeting of Ministers in Switzerland, the Ministers, most of whom were socialists, were happy to take the view that four years was quite a generous time for a prosecution and the mildest time to occur in any European state, so let us blow the trumpet on Scottish justice instead of blasting it.

Lord James Douglas-Hamilton: My hon. and learned Friend was a prominent and distinguished Law Officer and I congratulate him on getting the Age of Legal Capacity (Scotland) Bill through its Committee stage this morning.
He has retained his interest and is absolutely right to praise the Scottish legal system. We have reason to be proud of the 110-day trial system, which is envied by many other countries. Trials must start within 12 months of an accused first appearing on petition in serious cases. We can be justifiably proud of Scotland's criminal justice system—it is the best in the world.

Grampian Health Board

Mrs. Margaret Ewing: To ask the Secretary of State for Scotland when he last met representatives of Grampian health board to discuss reorganisation of the health service.

Mr. Michael Forsyth: I hold regular meetings with health board representatives to discuss issues affecting the NHS in Scotland.

Mrs. Ewing: Is the Minister aware of the grave disquiet throughout the Grampian health board area about the handling of the Foresterhill opt-out, whereby overwhelming medical and public opinion was overruled by what appeared to be Stalinist tactics at St. Andrew's house? Can the Minister define for the House the importance that he attaches to democratic expression of opinion? This matter greatly concerns my constituents because West Grampian unit is also currently undergoing a consultation process and it seems clear from the Minister's previous actions that consultation is meaningless and that his own views count more than anyone else's.

Mr. Forsyth: I am sorry that the hon. Lady should seek to politicise the matter. The initiative to look at national health service trust status for Foresterhill has come from management and medical people who believe that there will be an opportunity to improve patient care. I understand that consideration is also being given to the possibility of trust status in the West Grampian district, although I have no detailed knowledge of that as the initiative comes from the local districts. Should an application come to my right hon. Friend, as I understand that we expect it will, a three-month period of consultation will be required. I hope that the hon. Member for Moray (Mrs. Ewing) and others will apply only one criterion in assessing the application —whether patient care will benefit—and that party politics will be set aside.

Mr. Robert Hughes: Does the Minister not realise that the decision by the Grampian health board on 7 February to recommend that an opt-out application be made seriously prejudices the board's capacity to conduct the consultation period in an objective manner? If an application is submitted, how can the Minister ensure that the consultation period will be undertaken with the public confident that it will be neutral and that the facts will be properly and straightforwardly reported to the Minister so that he can follow his own criterion and apply a non-political judgment?

Mr. Forsyth: The decision will be taken not by Grampian health board, but by my right hon. Friend the Secretary of State, who will do so after a period of consultation. I understand that the Labour party has plans to use the common good fund in Aberdeen to campaign against national health service trust status. It would seem that the common good of Aberdeen would best be met by people looking at proposals that have come from those


involved at the sharp end of health care provision with a view to considering them in the light of whether they satisfy patient care.
Foresterhill started out as a hospital run by a board of management in the NHS. It has served Aberdeen extremely well, and those who argue for local community organisation and running do so because they believe that it is in the interests of Aberdeen and the constituents of the hon. Member for Aberdeen, North (Mr. Hughes).

Mr. Malcolm Bruce: Will the Minister answer two simple questions? Many people in Grampian are asking why the status quo was not an option with regard to Foresterhill. How can the people of Grampian have confidence in a health board which initially said that it had no locus in determining the result, was neutral and relied on a proposal from the hospital, but, when that proposal was not forthcoming, stated that it would have welcomed it? It now says that it will objectively consult the people of Grampian. How can the people of Grampian have confidence that the health board will take account of their welfare?

Mr. Forsyth: I should have thought that if the hon. Gentleman were interested in obtaining a genuine consultation period he would realise that the sort of remarks that he has made would not be helpful towards achieving that. The board's responsibility is to look at the requirements for health care in Grampian and, to the best of its ability and within the resources available, to provide for that. If the board believes that the initiative from doctors and management for NHS trust status is in the interests of patient care, I should have thought that, as a Member of Parliament, the hon. Gentleman would give careful consideration to the arguments put forward by the board and do his best to ensure that the consultation process is not turned into a political farce.

Mr. Andy Stewart: Does my hon. Friend agree that the criterion used to judge the success of the national health service is not the number of beds but the number of patients treated?

Mr. Forsyth: Indeed, I do. Some 900,000 extra patients are treated each year, compared with the number treated when the Government took power. Were NHS trust status —which is attracting interest in Grampian—to be forthcoming, it would mean that the hospital at Foresterhill would be able to take decisions at hospital level and those directly involved in the provision of care would have far more say in the decision-making process. It is ironic that those who argue for devolution on a political basis seem to be against it in the health service.

Local Government Finance

Mr. Wray: To ask the Secretary of State for Scotland what is now the average cost of collecting the poll tax in Scotland including extra expenses for new staff needed and for the processing of rebate applications.

The Parliamentary Under-Secretary of State for Scotland (Mr. Allan Stewart): Overall, Scottish local authorities have budgeted to spend £43 million on the collection of the community charge this year.

Mr. Wray: Does the Minister agree that this has been the most disastrous and costly piece of legislation this

century? Can he explain why the Minister of State and the Secretary of State for Scotland let the people of Scotland down so badly by failing to ask the Cabinet and the Secretary of State for the Environment to abolish the 20 per cent. rule? Why did he not raise, on behalf of the Scottish people, the fact that we were a year ahead of England? Why did he not ask for a £280 refund? Why did we have to pay £140 more?

Mr. Stewart: I must point out to the hon. Gentleman that we abolished rates in Scotland a year ahead of England. I refer the hon. Gentleman to the speech that I made during the debate on the 20 per cent. rule. I assure both the hon. Gentleman and the House that local authorities will be fully reimbursed for the cost of administering the additional assistance to charge payers that was announced by the Government.

Mr. Home Robertson: Will the Minister confirm that the cost of granting 100 per cent. poll tax relief to the poorest people in Scotland would be just £30 million? In all the circumstances with which we are familiar in our constituencies, how on earth can he justify the on-going campaign of his right hon. Friend the Secretary of State for Scotland to retain this tax on poverty in Scotland?

Mr. Stewart: The cost of collecting the community charge is about three quarters of 1 per cent. of total expenditure. If the hon. Gentleman is implying that local authorities should concentrate as a priority on pursuing those who are able to pay the full personal community charge but who are not doing so, I agree with him.

Mr. Dewar: The Minister referred us to his previous speech on the 20 per cent. rule. As he was a diehard supporter of the unjust principle that everyone, irrespective of means, including students and those on income support, should pay something towards local taxation, are we to take it from his remarks that the Government intend to stand by the 20 per cent. rule and that the new system to be announced will contain no reprieve? The Minister is known as the truest of blue supporters of the poll tax. Can he explain why he is now prepared to endorse a property tax? He will have heard the Secretary of State say a few minutes ago that the reason for the abolition of the poll tax is that it is not working well —yet only four or five months ago the Secretary of State for Scotland described it as a remarkable success story. What in the interim has changed the mind of the hon. Gentleman and his senior colleagues?

Mr. Stewart: The hon. Gentleman recognises, I hope, that he will have to await the consultation paper on the future structure of the new system of local government finance. [HON. MEMBERS: "So will you."] I should point out that collection levels are very variable. To take an example at random —[HON. MEMBERS: "Oh!"] It is from Eastwood district—[HON. MEMBERS: "Ah!"], so perhpaps not chosen wholly at random. The income raised in 1989 from Eastwood district was 103·4 per cent. of estimated income. That perhaps shows the wisdom of the hon. Member for Glasgow, Provan (Mr. Wray) who asked the main question, in preferring to continue to live in Tory Eastwood rather than in socialist Glasgow with his constituents.

Labour Statistics

Mr. Bill Walker: To ask the Secretary of State for Scotland if he will give details of the number of people in work in Scotland and north Tayside in May 1979 and at the nearest date in 1991 for which figures are available.

Mr. Allan Stewart: In September 1990, there were 2·25 million people in the Scottish civilian work force in employment. This was 12,000 more than in June 1979. In September 1989, there were 22,600 people in employment in north Tayside—about 1,600 more than in September 1984. These are the earliest and latest dates for which constituency information is available.

Mr. Walker: Does my hon. Friend agree that these figures show very clearly that a Conservative Government and Conservative Members of Parliament are good for Scotland, and certainly good for north Tayside? They show very clearly that the number of people in work is greater today than when I became a Member of Parliament, and those people are all better paid, making nonsense of the claims that people are not better off.

Mr. Stewart: I entirely agree with my hon. Friend's general point and with his particular point about north Tayside. His reference to living standards is correct. The best measure is gross domestic product per head. Throughout Scotland, GDP is at an all-time high, having increased by about 30 per cent. in the past decade. That shows beyond any doubt the benefits that the people of Scotland have derived from Conservative government.

Mr. Ernie Ross: The Minister is being rather selective. He will know, for instance, that the whole of Tayside has been shocked by the most recent job losses, which are a direct result of decisions made by his Government. I refer, for example, to the decision to instruct health boards to consider privatising some of their services. That was compounded by a decision of a sub-committee of the full health board, by a vote of three to two. The people who voted to make 380 people redundant were the chairman, who was appointed by the Secretary of State for Scotland, and two self-nominated members of the Conservative party, one of whom has a relative on the Government. side of the House.

Mr. Stewart: I am not sure whether the hon. Gentleman was referring to one of my relatives —or, indeed which one as there are a very large number of them.
Contracting out has saved the health service hundreds of thousands of pounds, and the money saved is going into patient care, where is belongs. When talking about what has been lost to Tayside, the hon. Gentleman might have taken the opportunity to express regret at the way in which the big Ford investment was thrown away by the trade union movement.

Strathclyde Police

Mr. Michael J. Martin: To ask the Secretary of State for Scotland what is the present number of police officers currently serving in Strathclyde.

Lord James Douglas-Hamilton: As at 31 December 1990, 6,804 officers were serving in Strathclyde police. This includes nine officers on secondment, 22 on central service, and 37 serving with the Scottish crime squad.

Mr. Martin: I thank the Minister for his reply. He will know that the chief constable of Strathclyde, Sir Andrew Sloan, complained in his most recent report that he was 210 police officers below strength, despite the fact that other forces throughout the United Kingdom had increased their numbers. The chief constable is alarmed that in some cases he will not be able to answer calls at peak times. Surely a Minister representing the party of law and order should do something about that.

Lord James Douglas-Hamilton: I am grateful to the hon. Gentleman for highlighting the matter. It is clear that Strathclyde regional council will not allocate sufficient funds to maintain the required establishment. Currently the force is 150 below strength. The Scottish Office, having approved the higher level, has properly budgeted for its share of the cost, so the problem lies wholly at the door of Strathclyde regional council. We have increased our payment from 50 to 51 per cent. The regional council's decision is extraordinary in view of the fact that theft and house-breaking have increased, as have drugs-related offences involving supply as well as those involving possession. I very much hope that the council will consider the matter again with a view to adopting a stronger law and order policy.

Mr. David Marshall: Will the Minister confirm that in many parts of Strathclyde only a handful of police officers are available in the evenings and at weekends to combat the activities of criminals? Is not that a charter for criminals? It is surely wrong for the Minister to lay the blame at the door of Strathclyde regional council in view of all the cuts that the council has suffered as a result of Government policies. Will the Minister give the council sufficient resources to enable it to do all that it can to combat crime?

Lord James Douglas-Hamilton: We have paid our share of the cost in grant and we have increased the grant from 50 to 51 per cent., as I mentioned. The responsibility lies firmly at the door of Strathclyde regional council. I hope that it will take seriously into account what the hon. Gentleman has said, bearing in mind that it is the only regional council in Scotland so far below the required establishment of police officers to do the job properly.

Mentally Handicapped People

Dr. Godman: To ask the Secretary of State for Scotland when he next intends to meet the chairmen of the local enterprise companies in order to discuss the number of people suffering from mental handicaps who require training places and the number of employment training places available to such people in 1991–92.

Mr. Allan Stewart: Discussions with the chairmen of local enterprise companies about operational issues of the kind to which the hon. Gentleman refers are matters for Scottish Enterprise and Highlands and Islands Enterprise. I am satisfied that the training resources available to Scottish Enterprise and the local enterprise companies are sufficient to cater for the employment training aim and guarantee groups. Those groups include mentally handicapped people.

Dr. Godman: Is there not one Scottish Office Minister or official with an abiding commitment to the needs of those fellow citizens who suffer from mental handicap of


one kind or another? Surely the local enterprise companies should be told by the Minister and his officials that they have a responsibility to such citizens. Would it not be an honourable course of action for the LECs to ensure that two or three of every 10 training places go to people with mental handicaps? Why should such people always be at the end of the queue for training and employment?

Mr. Stewart: I appreciate the hon. Gentleman's concern, but he is not up to date with the position. Last year employment training starts for people with disabilities, including the mentally handicapped, represented 6·2 per cent. of the total. This year from 1 April for the first time the disabled, including the mentally handicapped, will be part of the aim group for employment training, which effectively ensures them places in employment training. Indeed, we have relaxed the normal unemployment eligibility requirement. In effect, therefore, eligibility will depend on an individual's fitness for employment once trained and not on resources.

Mr. Worthington: Given the Minister's assurances, why are 500 handicapped people who previously received a service from the Scottish Society for the Mentally Handicapped no longer receiving that service after the employment training changes? Why has the Scottish Association for Mental Health had a cut of 140 places, and why are four or five centres to close? If there is genuinely a guarantee to the aim and guarantee group, which includes the handicapped, why has Lothian Enterprise given an instruction to all training managers that no more handicapped people or others in that group are to be taken on until further notice?

Mr. Stewart: May I reassure the hon. Gentleman completely that the mentally handicapped are part of the disabled category and part of the aim group? Therefore, their eligibility depends on fitness for employment once trained and not on resources. However, I should say that the purpose of employment training is to provide training directly; it is not to provide rehabilitation, which is a social work function. As to the Scottish Association for Mental Health, I launched Tayside Enterprise earlier this week. I asked about places for the SAMH and was told that it had contracted for 2,024 training weeks in 1991 and that the figure for 1991–92 is 2,600 weeks. That is not a cut—it is an increase.

Training

Mr. Watson: To ask the Secretary of State for Scotland what will be the effect of the reduction in Government funding to local enterprise companies compared with their bids on the number of training places they are able to provide in the next financial year.

Mr. Lang: There is no uniform link between the funds available to local enterprise companies and the number of training places that they are able to provide. The maximum number of training places that could be provided by each local enterprise company will be significantly influenced by the use that they make of the increased flexibilities available to them and the unit costs that they negotiate.

Mr. Watson: The increased flexibilities of which the Secretary of State talks are certainly not matched by increased funding. If Scottish Enterprise had been funded

at the level promised by the former Secretary of State when it was first mooted, it would have approximately £150 million extra available for local enterprise companies. That money could be spent on much needed training schemes, which are now having to be cut. What would the Secretary of State say to my constituents—trainees as well as trainers—whose training schemes were cut at the end of last month because of the underfunding of the Glasgow Development Agency?

Mr. Lang: The hon. Gentleman underrates the substantial sums now being invested in training in Scotland. The budget for youth training in the forthcoming year is £103 million and the budget for employment training is £115 million. Those sums are substantial. When one compares them with the small sums invested in training by the last Labour Govermment —about six times as much investment is now being made in training—it is clear that the Opposition have a lot to learn from the Conservative Government.

Sir Hector Monro: Does my right hon. Friend agree that the £429 million allocated to Scottish Enterprise, plus the £15 million for the Training Agency, should enable most trainers and trainees to enjoy good facilities in the coming year? Does my right hon. Friend know whether there will be a drop in the number of people receiving training in the coming year?

Mr. Lang: My hon. Friend asks a sound question. The total amount of resources going into the Scottish Enterprise training budget and the Highlands and Islands training budget is more than £240 million. Provided that the local enteprise companies use the flexibilities open to them and take maximum advantage of their negotiating position, that money should enable them to provide a substantial number of training places and to meet the guarantees that the Government have given.

National Health Service Trusts

Mr. McKelvey: To ask the Secretary of State for Scotland how many applications for health trust status he has received; and if he will list them.

Mr. Forsyth: At this point formal applications have been received from the south Ayrshire unit and the Royal Scottish national hospital.

Mr. McKelvey: In view of the unsatisfactory answer that the Minister gave to other hon. Members who asked a similar question, and given the fact that the vast majority of well-informed local opinion is opposed to the application, will the Minister give a simple and honest guarantee to the House? First and foremost, will he undertake an objective consultative process? Secondly, will he undertake that the results of that process will be looked at fairly and impartially? Thirdly, if the majority of those involved are not in favour of opting out, will he abandon or reject the request?

Mr. Forsyth: The answer to the hon. Gentleman's questions is yes, yes and no.

Fishing

Mr. Kennedy: To ask the Secretary of State for Scotland if he will assess the prospects for the fishing industry in the north and north-western coastal waters around Scotland; and if he will make a statement.

Mr. Lang: The prospects for the fishing industry in the north and north-west depend primarily on the health of fish stocks. The current poor state of the cod and haddock stocks in the North sea and off the west coast of Scotland is of particular concern. The Government therefore regard the conservation of those fishery resources as a major priority if we are to ensure the long-term prosperity of the fishing communities around our coasts.

Mr. Kennedy: The Secretary of State can surely be in no doubt as to the sense of utter chaos and demoralisation in the fishing industry and in the many communities served by and dependent on a healthy and viable fishing industry. Will he now acknowledge that schemes and devices such as the eight-day tie-up and all the problems that that is causing are no substitute for a proper, sensible and comprehensive decommissioning scheme? That is what the industry wants and it smacks of sense. Why have the Government turned their face against such a sensible development?

Mr. Lang: I certainly understand the anxiety that exists in the fishing community. I was able to find out more about that when I visited Peterhead recently. However, the industry also recognises the importance of conserving stocks because unless we do so in a responsible and sensible long-term manner there will be nothing left for the fishing community to fish for in the years to come.
The hon. Gentleman suggests that decommissioning might be the answer to all our problems, but that would be an extremely expensive scheme and, judging from precedents, there is no evidence to suggest that it would work effectively. It is significant that those countries that have decommissioning schemes also have other means of controlling their fishing efforts.

EC Directives

Mr. Andrew Welsh: To ask the Secretary of State for Scotland what meetings have taken place between the Scottish Office and the European Commissioner for the Environment on compliance with EC directives.

Lord James Douglas-Hamilton: The Scottish Office is in contact as necessary with the Commissioner over the whole range of environmental issues.

Mr. Welsh: Will the Government provide a supply of clean, wholesome drinking water for the Scottish population? Is not it disgraceful that millions of Scots are daily drinking water which fails to meet the basic minimum European standards for safety regarding materials such as aluminium and lead? Why were the Government willing to throw billions of pounds as a sweetener for water privatisation at one of the smaller English water boards when less than that amount would solve our problems and supply clean drinking water for the whole of Scotland? Why is the Minister discriminating against his own country?

Lord James Douglas-Hamilton: First, I must point out to the hon. Member that, unlike in England where water restructuring took place in advance of privatisation, that process is not taking place in Scotland, where the water service is in the public sector. We take seriously our determination to do everything possible to comply with the directives. We have increased expenditure on water and sewerage programmes to an all-time high of £620 million. The hon. Gentleman asked about aluminium and lead. As regards aluminium, most supplies will comply by 1994; as regards lead, only one of the treatment schemes remains to be completed after this year, and it is programmed for 1992.
As for our record of compliance, only three countries —Denmark, Luxembourg and the Netherlands—are expected to show fewer complaints pending against them. Of some 90 court cases launched by the Commissioner in the past 10 years, only two have been against the United Kingdom and they have been defended vigorously.

Kurds (Iraq)

The Secretary of State for Foreign and Commonwealth Affairs (Mr. Douglas Hurd): With permission, Mr. Speaker, I should like to make a further statement about the relief of the suffering in Iraq.
On Monday I reported to the House on the plan put forward by my right hon. Friend the Prime Minister to establish temporary safe havens in Iraq for the refugees until they can return to their homes in safety. I said that we were pressing the plan vigorously. I can now report good progress.
Following my right hon. Friend's initiative, we continued intense discussions with our close allies, particularly the French and United States Governments, our partners in the European Community and the Secretary-General of the United Nations. We warmly welcome the decision announced by President Bush late yesterday to establish, in conjunction with ourselves and the French, several encampments in northern Iraq where relief supplies for the refugees will be made available in large quantities and distributed in an orderly way. This is essential for the survival of the refugees. Security will be provided at these temporary sites by United States, British and French forces. The details are now, today, being worked out in close consultation with our allies and with the United Nations Secretary-General.
These proposals are to help provide emergency aid, as authorised by Security Council resolution 688. We regard these camps as temporary. They will provide first the emergency supplies and shelter needed to keep the refugees alive and, secondly, over time, the reassurance they need to move on in safety to their homes. This is an immediate measure designed to save lives. We shall be working closely with the United Nations. UN resolution 688 requires the Iraqi Government to co-operate, both with measures undertaken to ensure the implementation of that resolution and generally with the Secretary-General's efforts for the refugees.
Meanwhile, we shall continue our own additional relief effort. My right hon. Friend the Minister for Overseas Development gave evidence on this to the Select Committee on Foreign Affairs this morning. In addition to our contribution to the air aid bridge, we have contributed over £20 million to appeals by the United Nations and other agencies. We are supporting the efforts of our own non-governmental organisations, and our efforts are not confined to Turkey. My right hon. Friend will leave for Turkey and Iran tomorrow to help to ensure that the relief effort is being properly co-ordinated. Last week we sent 80 tonnes of relief supplies to Iran, and two additional flights, carrying a similar amount, will leave for Iran this week and more will follow.
The Iranian authorities and their Red Crescent are making strenuous efforts, but it is clear to me that a substantial build-up of the international effort to help the Kurds in Iran is essential and urgent.

Mr. Gerald Kaufman: The decision of the Governments of the United States, the United Kingdom and France to send troops into Iraq to protect and help Kurdish refugees falls clearly and precisely within the authority of Security Council resolution 688 which was carried on 2 April.
Throughout the crisis the Labour party has given full support to all 14 Security Council resolutions and has supported all action taken in accordance with those resolutions and all action taken with the authority of those resolutions.
We therefore welcome and support the action announced yesterday by President Bush. We welcome the participation in the decision by the United Kingdom Government and we give our full support to the British troops who are involved in this action.
Can the right hon. Gentleman give the House more information about the number of troops involved and what their tasks will be? Can he explain their rules of engagement and in what circumstances they would be authorised to take military action against Iraqi forces?
Iraq, of course, is obliged under resolution 688 to co-operate with the work our forces are doing and if Iraqi forces were to interfere in any way with this Mission they would be in breach of the resolution and it could be invoked.
Can the right hon. Gentleman give any indication of how long our troops will be needed for this assignment? Can he say what role is being played by the Secretary-General and by the Security Council, and whether the United Nations military staff committee has been involved or consulted?
Is it the intention of the countries involved to hand over this assignment of mercy to United Nations control and to United Nations forces? If so, when is that likely to be arranged?
Although this action is welcome and entirely proper, it does not, of course, deal comprehensively with the problem and does not claim to do so.
We on this side continue to regard the sums of money provided by the United Kingdom Government as nowhere near adequate to meet the scale of the need. Will the Government increase their contribution substantially and as soon as possible?
Has the right hon. Gentleman any reliable information about the reported negotiations between Saddam Hussein and the Kurdish leaders? Does he believe that any worthwhile outcome is likely if such negotiations are indeed taking place?
My right hon. Friend the Leader of the Opposition and I have raised in the House recourse to the United Nations genocide convention. Can the right hon. Gentleman now tell the House that, as we recommend, the Government will speedily ask for a meeting of the Security Council at which the Secretary-General will be asked to send a Mission to Iraq to investigate charges of genocide by Saddam Hussein against the Kurds and against others? Such a Mission is clearly authorised under resolution 688 and it ought to be sent urgently.
Can the right hon. Gentleman tell the House what action the Government would support under the genocide convention and what action could be taken to deal with those responsible for genocide, should such charges be established?
Article 4 of the convention authorises punishment against persons committing genocide, whether they are constitutionally responsible rulers, public officials or private individuals. Of course, the meeting of European Community Ministers on Monday with the participation of the United Kingdom supported trying Saddam Hussein for war crimes.
Since it is impossible to deal with one aspect of the middle east crisis without considering other actions and developments in the crisis, will the right hon. Gentleman —[Interruption.] These are very important matters and the right hon. Gentleman volunteered a statement to which the House has a right to respond.
Will the right hon. Gentleman endorse the condemnation by President Bush of the establishment of a new illegal Israeli settlement on the occupied west bank? We welcome the condemnation of that settlement by the Israeli Minister of Health and we hope that the Government will join that condemnation. We believe that all action has to be taken to deal with the Kurdish crisis and the wider middle east crisis, because one more is more than enough and there must not be another crisis.

Mr. Hurd: I am grateful to the right hon. Gentleman for his support for my announcement. The job of our forces will be to protect the relief effort in the camps that have been announced. On Monday I set out in some detail why we believe that protection to ensure the safety of the relief effort and the helpers and the helped is an essential part of the relief. Obviously, the protecting forces will be as heavy as is required, but as light as possible. As my right hon. Friend the Prime Minister said this morning, we reckon that our contribution is likely to be somewhat less than a brigade. It is not possible to answer the right hon. Gentleman's question about how long this effort will be needed, but we aim to hand over the function to the United Nations as soon as is practicable.
Last night my right hon. Friend the Prime Minister talked to the United Nations Secretary-General who made a general comment of welcome for the humanitarian purpose of this exercise. That is as far as I am able to go in answering that question by the right hon. Gentleman.
The right hon. Gentleman asked about money. The £21 million contribution announced by my right hon. Friend the Prime Minister covers the immediate practicable requirements of relief. The relief effort is going ahead and our effort is being intensified in the way that my right hon. Friend described to the Select Committee this morning.
I have no particular knowledge of any discussions between the Kurdish leaders and the Iraqis. We believe that the aim a0nd objective of the Kurdish leaders of autonomy with Iraq can be supported.
The right hon. Gentleman returned to the issue of genocide. He is correct to say that on 15 April the Community Foreign Ministers agreed that the Twelve should work towards Saddam Hussein's being held to account. They agreed to pursue that through the Secretary-General of the United Nations and that is being done. On Monday I set out the legal position of the 1948 convention. The practical position is that Saddam Hussein is not within our power.
My right hon. Friend the Secretary of State for Defence will make a statement as soon as possible—I should think quite soon, within the next day or so—about the outcome of the detailed staff planning discussions now going on in Germany. He will be able to set out more clearly the nature of the British military contribution to that effort. It is clear that we are making a contribution and that it is a logical and necessary result of the initiative by my right hon. Friend the Prime Minister.

Mr. Toby Jessel: On the safe haven for the Kurds, is my right hon. Friend aware that we are all

proud of the lead given by our country, our Government and our Prime Minister? Is he further aware that we are glad to have confirmation that there will be no let-up in the relief to the Kurds in the mountains and that we have every sympathy with the point of view of the Turks? To let Saddam Hussein stay on is similar to what would have happened at the end of the second world war if we had allowed Hitler, had he lived, to stay on to run Germany.

Mr. Hurd: I am grateful to my hon. Friend. My right hon. Friend the Prime Minister launched this initiative and persevered with it for weeks during which many clever people were saying that it was washed up, had been discredited and would never come to fruition. My right hon. Friend persevered to success. That is not only a great achievement by my right hon. Friend and the Government but will save the lives of many people about whom the Government and the country are concerned.
The point on which my hon. Friend ended is one into which we went fairly thoroughly in the House on Monday. I simply say that most people feel that a change of regime in Iraq is highly desirable—not least the Iraqis themselves, including the Kurds. However, none of the allies believes that that is best brought about by allied troops.

Sir David Steel: While I applaud the action that has at last been taken by the allies, may I ask the Foreign Secretary to say a little more about how he hopes to persuade the Kurdish people to remain within the northern Iraqi border, unless there are signs of longer-term guarantees for their safety? Will it be part of the peace settlement that there should be the creation of a secure homeland within the territory of Iraq, as the Kurdish leaders want? Will there be a similar operation on Iraq's south-eastern border with Iran?

Mr. Hurd: Our first thought was to save as many lives as possible, and the creation of the camps is designed to do that. As the right hon. Gentleman says, it does not solve the whole of the problem. I hope that it will lead to a willingness by the Kurds to return to their homes, but they will do so only if they are satisfied that those homes are secure. We believe that that involves the steady build-up of an international, United Nations presence in north Iraq. I hope that that will go ahead on the lines of Prince Sadruddin's mission to Iraq and his discussions there.
There are no plans for a similar exercise on Iraq's border with Iran. That is why I spent some time saying that I believe that the international relief effort in Iran, to which we are increasingly contributing, will need to build up quickly.

Several Hon. Members: rose—

Mr. Speaker: Order. It might help hon. Members if I say that I shall give precedence today to those who were not called on Monday.

Mr. John Wilkinson (Ruislip-Northwood): The measures that my right hon. Friend has announced are most welcome. Could he clarify the statement of the Secretary-General, after his meeting with President Mitterrand, that if allied troops deployed to protect the camps were to be under the auspices of the United Nations, that would have to be approved by another meeting of the United Nations Security Council? Will my right hon. Friend have regard to the potential of air cover,


because it is not just a question of protecting the camps; it is necessary to ensure that there is no further intimidation and harassment of the Kurds over a wider area.

Mr. Hurd: My hon. Friend is right on both points. It is not intended that the British, American and French forces, which I have described in my statement, should be under United Nations command. I am advised that their presence is wholly consistent with Security Council resolution 688. We want their role to be taken over by the United Nations as soon as that is practicable.
My hon. Friend is right about air cover. President Bush was specific about that in his announcement yesterday, and my hon. Friend will have noted that he specifically repeated the warning that he had previously given about Iraqi air activities.

Mr. Chris Mullin: May I gently put it to the Foreign Secretary—and I say it without any sense of satisfaction—that the Gulf war appears to be a rather less glorious enterprise today than it did a month ago? Whatever view one takes of that, there is no excuse for the triumphalism of some Conservative Members.
May I welcome the action that has been belatedly taken today, but point out to the Foreign Secretary that the immediate concern, which is widely acknowledged, is to get the Kurds off the mountains? That will require more co-operation from the Turks. Does the right hon. Gentleman share the widespread revulsion felt when we see on our television screens every night pictures of Turkish soldiers beating starving refugees to get them to go back up the mountains? Do we have any influence with the Turks? I am aware that the Turkish Prime Minister was in this country the other day. Are we using any influence that we might have, because, as yet, there is no sign that the Turks are co-operating on the scale that they should be?

Mr. Hurd: I simply do not understand the hon. Gentleman's first point. Is he saying, in some sense, that it would have been right to leave Kuwait under Saddam Hussein's mercy? Unless that is the implication of the hon. Gentleman's sentence, I do not see the point in saying it.
Of course we have been in close touch with the Turkish Government. My right hon. Friend the Prime Minister talked to the Turkish Prime Minister, as the hon. Gentleman said, when he was here on Monday. Obviously the Turks have sensitivities, concerns and substantial difficulties. They are making a massive effort and, rather than pick on particular incidents when things may well have gone wrong, it would be sensible if the House concentrated on how we can help, not criticise, the Turks.

Mr. Anthony Coombs: I congratulate the Government on their bold step of ensuring zones of safety for the Kurds which will prevent many thousands of them from dying on the mountain sides of the Iraq-Turkey border. Now that the principle of having troops inside northern Iraq under UN auspices has been established, does the Foreign Secretary see a role for the UN in future mediation between the Kurds and the Iraqi regime to establish permanent zones of safety and a constitution for them that will effectively guarantee their rights as citizens of Iraq?

Mr. Hurd: That is looking ahead. I certainly would not reject it. I believe that the Kurds are entitled to autonomy within Iraq. At the end of this story, the UN may well be helpful in bringing that about—I do not rule that out.

Mr. James Molyneaux: May I congratulate the Prime Minister and his colleagues on the success of their efforts in persuading their allies to take this effective action? Given the implications of the course on which we are embarked, would not it be prudent to have a careful, calm look with our coalition partners at the mid-term prospects and at strategy, as opposed to the longer-term middle east conference?

Mr. Hurd: I agree with that. The immediate short-term step that I have announced today on behalf of the Government needs to be followed by medium-term thinking—and I have begun to sketch what that should be. That applies to the Kurdish problem, to the problem of a final settlement in Iraq and to the wider middle east question about which the right hon. Member for Manchester, Gorton (Mr. Kaufman) asked me.

Mr. James Kilfedder: When the Prime Minister, out of a sense of deep compassion, put forward the idea of safe havens in Iraq, it was ridiculed by some and rejected by others, including the Government of the United States of America. So will the Foreign Secretary convey to the Prime Minister my thanks and those of the whole House for his decisive international leadership which may lead to the saving of tens of thousands of lives of Kurdish people?

Mr. Hurd: I will certainly convey the hon. Gentleman's thanks to my right hon. Friend. The United States did not reject the plan and has now decisively acted to put it into action.

Mr. Tony Banks: I am glad that the Prime Minister kept up his pressure for safe havens, because it seemed at one point that the President of the United States was going to wash his hands of his responsibilities, having perhaps achieved all that he wanted from the Gulf war. If one was writing a report on the Government it would read, "Could do better; could do more."
Does the right hon. Gentleman understand that, compared with the enormous efforts made in the Gulf war and the billions of pounds spent on it, £21 million—less than the cost of one jet aircraft—is a disproportionately small sum and that far more is needed? Are the Government prepared to spend far more; and what efforts are they making to encourage contributions from the Japanese, other EEC countries and Kuwait to pay for the costs of looking after the Kurds?

Mr. Hurd: The constraint is not a financial one at the moment. It is a matter of getting what is needed to where it is needed. If the hon. Gentleman knew the details of the relief effort, he would know that that was so. No doubt we shall return to talking about money, but at the moment the constraint is not financial. The hon. Gentleman's final point was quite right. Of course we must encourage not only our partners in the EC but the Japanese and the wealthier Arab states to help the relief effort. The Germans announced today quite a substantial airlift to Iran and the French have been extremely active and working closely with us particularly during the past few days.

Dr. Charles Goodson-Wickes: I also welcome the great success of my right hon. Friend the Prime Minister's robust diplomacy which has given some hope of alleviating the plight of the Kurds. Does my right hon. Friend agree that no troops in the world match the adaptability of British troops to move from a conventional military operation to giving humanitarian aid to a civil population?

Mr. Hurd: I agree entirely with my hon. Friend. In many places across the world our forces have shown exactly that quality and I am sure that when my right hon. Friend the Secretary of State for Defence gives details of how it is intended that our forces should operate, my hon. Friend will find that that principle is at work.

Mr. Tam Dalyell: In what circumstances can the House of Commons envisage British, American or United Nations troops ever being withdrawn from that place—will it be two years or 10 years? How does the Foreign Secretary contemplate the fact that we are creating a nightmare of a Northern Ireland in northern Iraq? Should not we at least try talking to Saddam Hussein, because, sooner or later, someone will have to talk to Baghdad, unpalatable though it may be?

Mr. Hurd: I really think that the comparison that the hon. Gentleman draws is very wide of the mark. I can see no similarities between the situations that he described.
If the Prime Minister had not put forward his initiative, if we had simply sat back, as the Opposition accused us of doing, if we had not pressed the United States or the European Community, or if yesterday we had refused to play our part, a great many more people who now have a chance of surviving would have died on the mountains. The hon. Gentleman has to accept that.
Of course I cannot tell the House today when this commitment will end. We shall try to bring it to an end in safety by handing over responsibility to the United Nations. There are precedents for that. I cannot say when it will be done, but it is a perfectly sensible method of proceeding. The United Nations has to keep in touch with whatever regime is in Baghdad. However, I hope that the hon. Gentleman will not use his eloquence to criticise or undermine in any way the chances of this operation, of which this country can be proud.

Mr. Paul Marland: Does my right hon. Friend agree that it is absolutely astonishing that, with only one exception, there has been not a single word of appreciation from the Opposition for what my right hon. Friend the Prime Minister has achieved? They seem to be more interested in whining and nit-picking about too little, too late, not enough and all the rest of it. Will he convey warm congratulations not only from me but from all my constituents on what the Prime Minister has achieved and emphasise that it is due to his tenacity and determination that a safe haven has been established for the Kurds?

Mr. Hurd: I am grateful to my hon. Friend. Of course, 'the Opposition had a bit of an outing on Monday when I was not able to say what was going on behind the scenes and I was not able to prove that the Prime Minister's initiative would bear fruit. I simply said that we were pursuing it vigorously. That was taken as a pattern of speech and the Opposition had a field day complaining that we were doing nothing. Now they have been proved

wrong and that rather inhibits them today. However, the right hon. Member for Gorton supported what we have announced and I am grateful to him.

Mr. Tony Benn: Is the Foreign Secretary aware that there will be widespread relief at the help now being given to the Kurds, particularly as probably 200,000 people have been killed in the area since the invasion of Kuwait and, in the opinion of many, the tragedy there is worse than it was when it began?
Is the safe haven a refugee camp? Does the Secretary of State recall that the Palestinians have been in refugee camps for many years? If there is military intervention to safeguard the camps, is not that a de facto partition? Do the Government accept the right of the Kurdish people throughout the area to self-determination? Will they be invited to the peace conference with the Palestinians? Without a long-term perspective, the aid—however welcome—will not go to the root of the problem.

Mr. Hurd: What we envisage is five or six refugee camps which will be protected by British, American and French forces. The camps will not be connected—it will not be a single territorial area but a number of camps. British, French and American troops will be equipped to protect themselves as well as others. The situation is not comparable to that on the west bank or the Gaza strip. I have set out what we believe to be a sensible attitude towards autonomy and we will support that claim. As I have already said, the United Nations may have a role to play in bringing that about, but we do not envisage a huge peace conference at which every issue involving the middle east will be considered.

Mr. Cyril D. Townsend: While paying tribute to the obvious compassion and thought that have gone into the programme, may I express my concern about the position of a brigade of British troops in a few days' time? Will my right hon. Friend confirm that, in the unexpected event of an ambush or attack, it will have no artillery or tanks with which to reply? How, in practice, will the brigade commander decide who is a displaced person and who is a freedom fighter? How will we stop the camps being used to store explosives and ammunition, bearing in mind that a vicious civil war is raging in that part of the world? The Government may find it easy to put a brigade of British troops into northern Iraq, but it will be hard to withdraw that brigade as long as Saddam Hussein and the Republican Guard remain in control of Iraq.

Mr. Hurd: That depends to a considerable extent on the exact location of the camps, which is being worked out at the moment. The answers to my hon. Friend's questions lie in the statement to be made by my right hon. Friend the Secretary of State for Defence when matters have been further elaborated. As I have already said, when we send British troops —and other countries will feel the same about theirs—they must be able to protect themselves as well as others. That bears on the question of equipment, communications, reinforcement and back-up generally. Those issues are very much in the minds of my right hon. Friend, his advisers and our allies.

Mr. Harry Barnes: How can we overcome the logistical problems of getting aid to the Kurds, which is causing great difficulty? People are collecting blankets, baby food and medical supplies to


assist the Kurds. A medical team—a burns unit—that has worked in Belfast is also going out to help. British organisations find it relatively easy to collect materials in this country, but they have great difficulty in shipping them over to the Kurds. Will help be given in that respect? I understand that Iran Air has to pay transit charges in this country when it is here on mercy Missions to collect some of those materials. Is everything being done to ensure that the materials that people have collected are getting to where they are needed?

Mr. Hurd: We started with air drops because that was the quickest but not the best way, as we have seen. We are now moving to helicopter drops, and the extra British helicopters that have been allocated are now arriving and will participate in those drops. The hon. Gentleman is perfectly right. The Red Cross is well equipped in this country to gather material and to get it abroad. That organisation is in close touch with my right hon. Friend the Minister for Overseas Development. I suggest that individuals or groups who want to help should contact the Red Cross or my right hon. Friend's Department.

Mr. Nicholas Soames: Will my right hon. Friend contrast with the Government's response the entirely graceless and negative response of the right hon. Member for Manchester, Gorton (Mr. Kaufman) and the Labour party to this remarkable achievement? Does my right hon. Friend agree that this achievement represents a triumph for British diplomacy and again shows the importance of working with our European partners in dealing with difficult matters involving the Americans?

Mr. Hurd: My hon. Friend is being a little hard on the right hon. Member for Gorton, who began his intervention this afternoon by accepting what the Government did, just as he did on the radio this morning. The right hon. Gentleman does not seem to have had total influence on his hon. Friends, but we are obliged to him for his support.
I draw from this issue a lesson that I have had to draw before: in these matters, persistence is all-important. If one is discouraged by the first discouragements, one will never get anywhere. We have persisted in this basic idea and I am delighted that it has succeeded.

Ms. Clare Short: Like everyone else, I welcome this belated action to bring relief to the suffering of the Kurds, but I do not understand one point. Why did not the right hon. Gentleman and the coalition forces give immediate support to the uprising for democracy in Iraq, uniting the Kurds and the Shi'ites, which occurred immediately after the ceasefire? Why did we not give humanitarian and medical aid and political support then? If we had done so, Saddam Hussein would probably have gone by now and the Kurds would never have had to go up the mountains.

Mr. Hurd: I do not think that historians will back the hon. Lady on that point. On Monday, we discussed whether the war was brought to an end at the right time. I do not believe that prolonging the fighting in the south for a day or two would have altered events for the Kurds. As soon as the extent of the humanitarian catastrophe became apparent—first in the areas around Turkey and

now in the areas around Iran—the international community took the action that I described today and on Monday.

Mr. Nigel Forman: Is my right hon. Friend aware that my constituents share the admiration for the lead that my right hon. Friend the Prime Minister has given, which has been voiced on both sides of the House by all fair-minded Members? Will my right hon. Friend confirm that Security Council resolution 688 insists on an immediate end to the repression of all minorities in Iraq, including the Kurds and the Shi'ites? What evidence is there so far that the Iraqi Government have in any way complied with that resolution? What steps do the Government intend taking to encourage them to do so?

Mr. Hurd: We know of no harassment by the Iraqis of the relief efforts. There is evidence of Iraqis continuing to attack Kurds south of the 36th parallel where the United States interdiction holds sway. We are waiting for the report of the Secretary-General's representative on the carrying out of resolution 688.

Mr. Bernie Grant: The Foreign Secretary praised the Turkish Government for their work in dealing with the refugees. Will he also praise the Iranian Government for their work? They have done considerably more than the Turkish Government. Will refugees on the Iran-Iraq border be able to go to the enclaves? If not, why not? If they are allowed to go to those enclaves, how will they get there? Will the Kurdish refugees, the fighters and the guerrillas be allowed to take their guns and other weapons with them into the enclaves?

Mr. Hurd: The hon. Gentleman is right on his first point. I referred in my statement to the strenuous efforts made by the Iranian authorities, including the Iranian Red Crescent. which I am told has done extraordinarily energetic and successful work in dealing with this disaster.
There will be no examination of people when they enter the camps about where they came from. In practice, it is unlikely that people will come from Iran or from the border with Iraq, but that will depend on where the sites are located, which is being worked out at present. I do not envisage the sites being allowed to be used by Kurds or anyone else carrying arms.

Mr. John Butterfill: Does my right hon. Friend agree that the Iranian Government's action in allowing so many refugees to enter their territory is to be praised, as is their restraint in the face of provocation from Saddam Hussein? Does not that augur well for future relations with Iran and, perhaps, for the future of some of the hostages in Lebanon? As for the refugees in the south, particularly those in the demilitarised zone, is not it our responsibility to see that they are given safe passage to a safe place if no safe havens are to be created in southern Iraq?

Mr. Hurd: I agree with my hon. Friend's remarks about the Iranian Government's policy. My right hon. Friend the Minister for Overseas Development will have an opportunity to discuss the subject with Dr. Velayati and others when she goes to Tehran on Saturday.
My hon. Friend's second point has exercised us, but is not a question which has arisen in the House before. It is extremely important that, before the Americans finally


leave the demilitarised zone, there should be more provision for the people who have taken refuge there. The best way is for them to be admitted to Kuwait or Saudi Arabia. Alternatively, the United Nations High Commissioner for Refugees should take effective control of the places that they occupy. That means resisting any effort by Iraqi forces to move in on those people.

Mr. Dick Douglas: Does the Foreign Secretary accept that it is a welcome development, when there is a conflict of interest between not interfering in another nation's affairs and humanitarian intervention, that the balance of advantage has been adjudged on the side of humanitarian intervention? Nevertheless, can we have a clear statement as soon as possible from the Secretary of State for Defence about the command structure to be deployed and the rules of engagement?
May I press the Foreign Secretary a little on how he anticipates the real and eventual needs of the Kurdish people being realised at a peace conference? They want a clear understanding that their accredited representative will be present and able to speak on their behalf.

Mr. Hurd: My right hon. Friend's statement will deal with the hon. Gentleman's first two questions about command structures and rules of engagement. It is impossible to look too far ahead at the eventual position and settlement of the Kurdish people. I have set out what I believe it is reasonable for this country to support and aim at, and we shall continue to do that through the United Nations.

Several Hon. Members: rose—

Mr. Speaker: Order. I must have regard to subsequent business before the House. This is an Opposition day and there is another statement and a ten-minute Bill, so I shall call three more hon. Members from each side before we move on to the next statement.

Mr. Bowen Wells: Is not it characteristic of my right hon. Friend the Prime Minister that he first recognised the humanitarian needs and desperate position of the Kurdish people and, secondly, recognised the real concerns of the British people? Undeterred by every legal and other formulation put forward by the Opposition in great chorus last Monday, he persisted and got the safe havens established. Is not it also essential that the Kurds do not stay in the safe havens for too long but that they be established where they belong, in their own homes and towns? They should be permitted, under United Nations authority and with the help of the international community, to live their lives in peace and security. Surely we must be prepared to back the United Nations force with armed might if necessary to defeat Saddam Hussein, who has turned them out of their homes.

Mr. Hurd: We have announced today our willingness to deploy our forces in support of the first task, which is to save lives. That has been almost universally welcomed in the House. The next step is that the United Nations must take responsibility for the camps now being set up and must find ways in which the Kurds can return to their homes in security. We do not want to establish, either in Turkey or northern Iraq, camps that start as temporary and end up as permanent. Clear responsibility rests on the United Nations and is already set out in resolution 688.

Mr. Alan Williams: I welcome the statement on the safe haven, but may I ask a question of pure logistics? Thousands of these desperate people died in the trek into the mountains. We are all aware of the difficult mountainous conditions, the poor weather and the weakened medical condition of those who survived the trek in; now they have to get out. That will be as big a problem as looking after them when they get out. What consideration is being given to ways of getting them out of the mountains?

Mr. Hurd: That is indeed an important part of the planning. As my right hon. Friend the Minister for Overseas Development has just told me, priority is to be given to getting women and children—the people who are most vulnerable—into places of safety first. That is already being planned and, to some extent, is already happening. The urgency of the matter is huge, which is why it seemed to us right that as soon as the American decision was cleared we should announce our acceptance of it and get on with detailed planning, while acknowledging that there are many basic questions that still have to be tackled.

Mr. Robert G. Hughes: Does my right hon. Friend agree that the dogged determination with which the Prime Minister pursued the policy he put forward against the rubbishing by the press and some other world leaders, whom he persuaded to come round to his way of thinking, should be pointed out to the Iranian leadership so that they understand that when the British Prime Minister says something, he means it and when he says that we need freedom for our hostages, including John McCarthy, who today finishes five years in captivity, the British Government mean it? We will have good working relationships with Iran, but only when John McCarthy and the others are free.

Mr. Hurd: I have made this point to Dr. Velayati since the autumn. Mr. Cooper, who was held in prison in Tehran for a long time, has now been released, which is welcome. But Iranians know that, alongside the way in which we praise them for what they are doing in the Kurdish crisis, acknowledge the immense difficulties they face and do our best to help them, we cannot forget, any more than hon. Members wearing their yellow ribbons today forget, that held in desperate conditions in prisons in the Lebanon are people over whose captors we believe the Iranian Government have influence. We hope that they will use that humanitarian influence to the best effect and get those people out.

Mr. Thomas Graham: While I am delighted with today's statement, I am deeply disappointed that the United Nations did not act a lot sooner to save the thousands of lives that have been lost in the mountains. I give this decent, sensible suggestion to the Secretary of State. During the Gulf war, contingency arrangements were made all over Europe for hospitals and other organisations. At present, there are thousands of people lying in the mountains who are desperately ill and in need of care and attention. Cannot helicopters fly them out and aeroplanes take them to Britain and Europe where they may be treated and restored to health? If the Government mean what they say, they should carry out that decent. sensible suggestion.

Mr. Hurd: There may well be such cases, but the essential need is to get medical help to where there are large


numbers of people. As I said on Monday, we are talking not about elaborate surgical equipment but about the basics of medical care and disease prevention. Getting that care to where the people are is the priority.

Mr. George Walden: Does my right hon. Friend agree that the people of this country expect the same display of unity in defence of the Kurds as was shown by the House in defence of the Kuwaitis? The Prime Minister's leadership in this matter deserves the unambiguous support of the House in the same way that his leadership of the Gulf war deserved it. However, in this complex situation, no policy can be perfect. One possible side effect of the policy of the Government and the United States is that it could release some of the Republican Guards for repression elsewhere in the country, by virtue of the fact that part of Iraq will be effectively neutralised. That seems to bring us back once again to the source of the evil—Saddam Hussein. What is happening in the international sphere to reinforce existing sanctions and to bring new, internationally backed sanctions against Saddam Hussein, the source of the evil?

Mr. Hurd: The sanctions regime, put into effect by United Nations resolution 687, is extremely rigorous. If my hon. Friend studies its exact provisions and puts himself in the position of someone in Baghdad who wants to have a future for himself, as an Iraqi, and for his family, he will see, looking at the provisions of the United Nations resolution, that the obstacle to that future for himself and Iraq is Saddam Hussein. I believe that that realisation will, in the end, be his undoing.

Mrs. Ann Clwyd: As my right hon. Friend the Member for Manchester, Gorton (Mr. Kaufman) said, we welcome any relief that can be brought to refugees who are living in such terrible circumstances, but several questions remain. First, can the Foreign Secretary tell us the size of the tent cities that are to be erected on the Turkey-Iraq border, but not on the Iranian-Iraq border? As he knows, the major problem is the refugees in Iran who have crossed into Iran from Iraq. Many more refugees are crossing the Iranian border than the Turkish border.
Secondly, what means will be made available to the thousands of Iraqi Kurds who still remain in the major cities of Iraqi Kurdistan—Sulaymaniyah and Kirkuk? No protection seems to have been made available to them, although battles continue in both cities, with a major battle taking place today in Sulaymaniyah.
Thirdly, is the Foreign Secretary aware of the conversation I had a few hours ago with Jalal Talabani in which he gave his views of the proposals? He said that the

tent cities are only good for keeping the refugees alive and that the main problem is to prepare conditions so that they can be sent back to their villages and towns under United Nations protection.
Fourthly, is the Foreign Secretary also aware of the proposals that have been made to the Iraqi Kurds during the last few hours by Saddam Hussein? The proposals are almost unbelievable. He has made what Jalal Talabani said was a very attractive offer, and they are to meet tomorrow to decide how to deal with the offer. He also said that Saddam Hussein is offering autonomy to the Kurds in Iraq, as well as democracy and pluralism and an elected Parliament with Kurdish representatives. That is unbelievable to all of us. Since it was mentioned to me by the leader of the major Kurdish political party, who is also the leader of the Peshmerga, that they are considering the proposal seriously, will the Foreign Secretary tell us what credence he gives to the report? If they are realistic proposals, which I know it is very difficult for all of us to believe, does the Foreign Secretary agree that they cannot be considered unless international guarantees are given to the Kurds, together with a guarantee that the withdrawal of all hostile forces from Kurdistan is overseen by the United Nations?

Mr. Hurd: I would rather not comment on detailed offers of a few hours ago, from whatever source, but I suppose that the Kurdish leaders will not be impressed by verbal offers. They will want an assurance, not just from whatever regime there is in Baghdad, that what is on offer is going to happen.
As for the hon. Lady's other points, no, it is not possible at this stage to give an estimate of the size of each of these camps. They will be largish. Unless the five or six camps are largish they will not make a sizeable impression on the problem. The hon. Lady is perfectly right. As I said in my original statement, this move does not solve the problem along the Iranian border, which she visited. That is why it is important that we, and other members of the international community, should build up the effort there.
On the question of the Kurds—indeed, all kinds of Iraqis, including the Shi'ites in the south who are in towns and villages—it is the purpose of the Secretary-General's co-ordinator, Prince Sadruddin, to visit the area and to report on how exactly the problem could be tackled. Prince Sadruddin has visited the area and will be talking to the Secretary-General in Paris today. We look forward with intense interest to his recommendations.

Several Hon. Members: rose—

Mr. Speaker: Order. I say to those hon. Members who have not been called to put questions on this statement that I shall bear them in mind next time, as I have borne in mind today those who rose on Monday but were not called.

Teachers' (Review Body)

The Secretary of State for Education and Science (Mr. Kenneth Clarke): The Government have been considering the best approach to the settlement of teachers' pay and conditions in England and Wales in the light of other developments, including discussions during the Committee stage of the School Teachers' Pay and Conditions Bill, the fourth report of the Interim Advisory Committee on School Teachers' Pay and Conditions, and progress in implementing the education reforms.
As I made clear when I was appointed to my present office, I share my predecessor's concern that we should have a well qualified and well paid teaching force, dedicated to serving the needs of pupils. The Prime Minister has expressed his strong personal commitment to those same aims. He and I want to reinforce the professionalism of teachers, and we want to raise still further the esteem in which the teaching profession is held in our society.
The work of the interim advisory committee has, we believe, been of great importance in encouraging teachers' professionalism by avoiding conflict about the level of their pay. In practice, the operation of the committee has meant determining teachers' pay in much the same way as that of doctors, dentists, nurses and midwives in the national health service, who are similarly committed to the needs of their patients. We have decided that it would be better to continue this broad parity of treatment for these key professions rather than return teachers to collective bargaining, which has caused so much conflict in the past.
Previously, the Government took the view that a review body for teachers could not be established because of the emphasis teacher unions had placed on their ability to take industrial action. We believe that that situation has changed—indeed, changed substantially in the last few months. Teachers have worked with great professional commitment on the implementation of the 1988 reforms. The recommendations of the interim advisory committee, culminating in its fourth report earlier this year, have produced a more progressive and flexible salary structure which has won support across a very broad spectrum of teacher opinion. The public and the vast majority of teachers do not want to see any return to industrial action affecting the education of pupils. In my opinion, the reaction to the antics at the Easter conferences of one or two of the teacher unions underlined that only too clearly. I am confident that the public will welcome the Government's acknowledgement of the professional status of teachers, and our offer to them of the review body status reserved to certain key non-striking professions.
Accordingly, I now propose that teachers' pay and conditions should in future be determined by an independent review body reporting to the Prime Minister, alongside the review bodies for the health service, the armed forces, and senior civil servants and the judiciary. This proposal is made on the basis that teachers fully recognise and accept their professional responsibilities, and will not in future take industrial action about matters within the review body's ambit. The Government, for their part, will undertake, as in the case of the other review bodies, to implement the review body's recommendations unless there are clear and compelling reasons to the

contrary. The recommendations will apply to teachers in maintained schools, except those grant-maintained schools that choose to make their own arrangements.
Teachers are not Government employees, and their pay is not directly financed from the Exchequer. So unlike the other review bodies, the schoolteachers' review body will have to be statutory. It will have to cover conditions as well as pay, as do both the present IAC arrangements and those in the School Teachers' Pay and Conditions Bill. The body will not be subject to a predetermined financial constraint, but, as with the IAC, I shall direct it each year as to considerations to which it is to have regard. These considerations will include, as now, the Government's view that school teachers' pay should be such as to recruit, retain and motivate sufficient staff of the appropriate calibre within what can be afforded, as expressed at present in the level of education standard spending set by the Government.
I attach particular importance to allowing schools the scope to tailor pay to their own needs in the light of local labour markets. Through the work of the interim advisory committee schools have recently acquired the freedom to choose from a wide menu of options within a national framework. I expect the review body to build on that approach. The grant-maintained schools will be able to make their own arrangements if they want to go further.
Like other review bodies, the teachers' review body will take evidence from all the parties concerned —in this case the teacher unions, the employers and the Government. Once the review body has made its recommendations, the decision on their implementation will rest, in the same way as applies to the other review bodies, with the Prime Minister.
Accordingly the Government are now withdrawing the School Teachers' Pay and Conditions Bill. Instead I shall bring forward as soon as possible a new Bill to give effect to the decisions I have announced today. My intention is to secure Royal Assent in time for next year's settlement to be determined by the new body. I reiterate the Government's determination to give practical effect to our desire to enhance the professional standing of teachers. I confidently expect their whole-hearted co-operation with these new arrangements as an essential element in that process.

Mr. Jack Straw: The Secretary of State has just made a statement of which he and the Government should be thoroughly ashamed. By it he highlights the chaos, confusion and indecision into which the Government have descended, and displays contempt for the House and the grossest breach of faith with the teaching profession. Does the Secretary of State recall that, when teachers' negotiating rights were originally removed by the Government in 1987, their restoration was promised by 1990, that the Government reneged on that promise, and that, when the School Teachers' Pay and Conditions Bill, which partially was to restore those negotiating rights, was brought to the House only 16 weeks ago, this Secretary of State said:
The Bill contains the agreed policy of this Government. I can certainly speak for two of the candidates for the position of Prime Minister who are committed to the Bill".—[Official Report, 27 November 1990; Vol. 181, c. 743.]
One of those candidates was the man who won the Tory party leadership.
Does the Secretary of State also acknowledge that day after day in Committee his Minister of State and


Under-Secretary expressed their commitment to the Bill and their desire to see it on the statute book? If that was the agreed position of the Government 16 weeks ago, what has changed since? [Interruption.] I will come to that. Where is the explanation for the extraordinary about-turn —not in 16 weeks but in the 10 weeks since the Bill left Committee?
Will the Secretary of State explain what consultation there has been since the Bill left Committee about the new policy which he has just announced? Has there been consultation with the teacher unions which he prays in aid? Has there been consultation with the employers? Does not the Secretary of State recognise that he will do further damage to the already collapsed morale of the profession if he tries to railroad his proposals through without their consent and that of the employers? Does not he recall that the interim advisory committee, which reported last year and again this year that teachers' morale had never been lower, called for a restoration of negotiating rights?
No one in the House wants to see any industrial action in our schools. I think that the whole House will know that I have been quite outspoken against those proposing disruptive action in schools which cannot be justified. But that is a very different proposition from the unilateral removal of the right to strike which the statement implies. Will the Secretary of State explain how he intends to enforce the no-strike arrangement of the proposals? Does he intend to write it into law? Will he accept that if he does that he will be depriving teachers of human rights which are not denied —

Mr. Martin M. Brandon-Bravo: What about the rights of pupils?

Mr. Straw: It is interesting that the hon. Gentleman, who fought for the right to strike in Poland, Czechoslovakia and Hungary, wants it to be taken away in this country unilaterally and without negotiation.
Will the Secretary of State accept that he will be depriving teachers of human rights not denied to any civilian group, apart from the police? Even nurses and doctors, who are subject to review bodies, are not denied the right to strike.
If the teacher unions refuse the proposals, what happens then? Are teachers to be denied a pay rise if they do not agree to withdraw any right to strike? Are they to be denied bargaining rights? Will the Bill be brought back, or will the Secretary of State simply continue with the 1987 system of imposing pay rises? If anyone reads the small print of what the Secretary of State said, it emerges that the proposed review body will be constrained on its global sum—as the right hon. and learned Gentleman admitted —in exactly the same way as the interim advisory committee. What extra will teachers get in exchange for that committee?
The Secretary of State referred to the fact that grant-maintained schools—opted-out schools—will be able to opt out of these arrangements. Will the right hon. and learned Gentleman confirm that, remarkably, that means that teachers in opted-out schools will continue to have the right to strike in pursuit of a pay claim while that right will be removed from teachers in local authority schools? There can be no other conclusion to be drawn

from the statement but that teachers in opted-out schools can take strike action in pursuit of a pay claim while those in local authority schools will be denied that right.
When I and my hon. Friend the Member for Copeland (Dr. Cunningham) asked the Leader of the House and the Secretary of State about the reasons for delaying the Report stage of the School Teachers' Pay and Conditions Bill, they referred, unbelievably, to pressures of parliamentary business. The Secretary of State, however, knew that that excuse was utter nonsense and had no basis in fact. He knew that hon. Members were bound to be misled by that excuse. Since that is the truth, would the right hon. and learned Gentleman now like to apologise for having taken the House for a ride?
The Secretary of State has wasted a great deal of hon. Members' time by abandoning a Bill that only four months ago represented the agreed policy of the Government. Ministers, by reneging on undertakings given to the profession and by their conduct, have shown that they are simply not fit to govern, and that it is time for them to go.

Mr. Clarke: I must admit that, while I sat here listening carefully as the hon. Gentleman waffled on in a state of rather confused indignation, I was waiting to hear whether he would announce that he was in favour of the review body to be established for teachers or against it. He gave no suggestion from beginning to end as to his opinion. [HON. MEMBERS: "He is a ditherer"]. Yes, he dithered.
The hon. Gentleman suggested that he had misun-derstood one feature of my announcement, because the review body will not operate under any predetermined financial constraints, just as the present review bodies do not.
The one thing that the hon. Gentleman chose to get indignant about was my threat to the teachers' right to strike. He defended that with all the passion of the NUT militants who took the headlines briefly at the conferences at Easter. The NUT executive gave every impression that it shared my view and the view of the public, that most teachers do not want to hear people going on about their right to strike. They do not want to take strike action against pupils. They want to be treated with the respect for their professional status which the Government's review body recommends.
We are not going to take away that right by law. We shall proceed on the basis that has been borne out by the vast majority of the trade unions, and even the majority of the members of the NUT. Teachers will not take strike action on matters within the remit of a review body because that body gives them the professional status alongside doctors, dentists, nurses, midwives, judges even, to which teachers have long aspired.
The hon. Gentleman put forward the ridiculous proposition that grant-maintained schoolteachers will retain the right to strike. I have always welcomed the idea of the hon. Gentleman suddenly launching himself on a campaign across the country trying to get schools to opt out of local authority status, so that their teachers can enjoy the privilege of organising strike action.
Unfortunately, I do not believe that I can have the hon. Gentleman on my side as an ally because, obviously, grant-maintained schools will work against the back-ground determined by the review body. I also believe that it is right that the governors of those schools, should they want, can make such variations in employment as they


think fit, in exchange, no doubt, for agreements with their teachers on things such as longer school hours and extra-curricular activities. All those things are within the remit of governors of grant-maintained schools.
As for the ridiculous argument about parliamentary time, the hon. Member for Blackburn (Mr. Straw ) did not listen with sufficient care to what we said on Second Reading and in Committee. My hon. Friend and I have been contemplating and discussing this policy for some time. When the hon. Gentleman looks back at the debate on Second Reading and in Standing Committee he will realise that we were careful to leave our options open. As time went by, it became clear that the climate was changing.
The hon. Member for Blackburn asked for the explanation for our change, compared with this time last year, when my right hon. Friend, who is now the Lord President and Leader of the House, was very attracted by the notion of a review body. At that time the air was still full of talk of industrial action, bargaining rights and so forth. In the past few months it has become steadily clearer that at least three trade unions are now campaigning for a review body, a fourth appears to have joined them and a fifth will accept it. The reaction to talk of strike action at teachers' conferences is now listened to with respect only by people such as the official spokesman of the Labour party, who has just allied himself with such people.
I hope that he will reflect carefully upon the position and come to welcome what I believe is a significant step forward for the teaching profession in this country, giving the people who teach our children the esteem and respect that they deserve.

Mr. Alan Haselhurst: Does my right hon. and learned Friend accept that many thousands of teachers will feel that his decision today enhances their professional rights, whatever else it does, and this will be a welcome step? Is the wisdom of his decision not further reinforced by the evidence of the valuable work done by the interim advisory committee? Does that not provide a sound example of the way in which a review body could work to the great advantage of teachers and their professional status?

Mr. Clarke: I am grateful to my hon. Friend and I agree with him. One can find on the record remarks by the hon. Member for Blackburn praising the work of the interim advisory committee, which has indeed produced a welcome improvement, especially in local flexibility in settling teachers' pay. The difference between the new review body and the interim advisory committee that it will replace is that the new body will not work within any predetermined financial remit. It will be enjoined to have regard to affordability and the need to recruit and retain, just as we always invite the other review bodies to have regard to those matters, but there will be no predetermined financial remit. Also the body will be appointed by the Prime Minister and report directly to him. He will give effect to its recommendations unless, as we have always said with all review bodies, there are clear and compelling reasons for not doing so.

Mr. Martin Flannery: In addition to the shocking statement made by the Minister —[Interruption.] The guffaws and laughter on the Conservative Benches at the destruction of democracy are appalling. The International Labour Organisation of the

United Nations has repeatedly condemned the Government for destroying free negotiating rights for teachers, although not for other unions. It is no good the Government talking about education, which they have got into an awful mess which has forced them to this point. They do not understand where they are.
Will they reconsider this matter? Conservative Members are laughing and guffawing at free negotiation, which is one of the fundamental rights of negotiation, one of the rights that is the difference between tyranny and democracy. They must be ignorant of what that means to do such a thing because it is bound to cause the opposite. Therefore, I ask the Minister once again— [Interruption.]—

Mr. Speaker: Order.

Mr. Flannery: In the face of such appalling ignorance it is difficult to ask my fundamental question. My question is one of many questions—[Interruption.]—

Mr. Speaker: Order. It is very good to see the hon. Member back, but could he bring his question to a conclusion?

Mr. Flannery: My question is, when are the Government going to obey the ILO injunction and give back negotiating rights to teachers because the absence of those rights will cause the very thing that they say that they do not want to happen in education—some kind of action, which we are opposed to?

Mr. Clarke: I too am glad to see the hon. Gentleman back in his seat after his period of sickness, and I trust that he is fully recovered, which he certainly appears to be. May I also point out to him that the ILO has never rejected the concept of a review body for any professions in this country that have enjoyed the privilege of review body status for many years. It would be most unwise to do so, because doctors and nurses, for example, have done well compared with others in the public sector as a result of the recommendations of review bodies.
The hon. Gentleman talks about the noise in the House, but there is very little noise coming from the Opposition side because there is scarcely a Labour Member in the House. He comes here as a lonely relic of the hard left, expostulating about teachers' right to strike and, extraordinarily, the Front Bench Opposition spokesman, the hon. Member for Blackburn, has allied himself with the hon. Gentleman. Frankly, teachers do not want to hear about the privilege of striking; they want to hear about the professional status that the Government are giving them today.

Mr. Alistair Burt: Does my right hon. and learned Friend agree that it is one of the fundamental rights of a child to have uninterrupted education? What is important is the creation of a climate in schools in which strike action will not even be contemplated. The proposal that he has announced today for a pay review body will be welcomed by the vast majority of teachers, who do not think that the right to strike is the most important thing in their lives, but that it is the professional delivery of a service to their children, which they have done remarkably well since the introduction of the reforms. What my right hon. and learned Friend is proposing today will set the


right climate for the future so that the uninterrupted right to education that all children need now looks more likely than it has done for some years.

Mr. Clarke: I endorse all my hon. Friend's sentiments. Three or four years ago, there was a most unhappy period of industrial dispute in our schools. I think that all the more sensible people in teaching, in politics and among the public resolved that that should never again happen if it could be avoided, because it was so bad for teachers and for pupils. I think that there will be a wide welcome among the teaching profession and the general public for the sentiments that my hon. Friend has uttered.

Mr. Matthew Taylor: In marked contrast to his predecessor, the Prime Minister and his team seem to have raised the status of the U-turn to a fine art. This proposal is another example of that, following the poll tax U-turn. The Secretary of State must agree that the confusion and indecision cannot have helped morale, no matter what today's decision may do. Our position as a party will be to try to get a resolution to this—I hope that all parties will do that—that will be long-lasting and will start to rebuild teacher morale. Nothing that the Government have done in the past few months has achieved that. We shall not block this Bill and will attempt to make it work. In doing that —

Mr. Speaker: Order. This is not a debate. Could the hon. Member now ask a brief question?

Mr. Taylor: Will the Secretary of State, in trying to make a package that will meet widespread acceptance, consider including within it the creation of a general teaching council? Will he reaffirm to the House that he will make every effort to work with all parties in the House so that a Bill is achieved this year in time for the next settlement, rather than have the present interim arrangements continue indefinitely?

Mr. Clarke: This is a firm proposal and we shall produce a Bill shortly. Our aim is to get Royal Assent as rapidly as possible so that the new arrangments can work in April 1992. I am delighted to hear that the hon. Gentleman will not oppose our proposals, and if we have helped bring the Liberal Democrats to a conclusion on the subject we have served a worthwhile purpose.

Mr. David Nicholson: Is my right hon. and learned Friend aware that my constituents in Taunton, where we have one or two difficulties with his Department to which I may have to refer next week, will greatly welcome today's statement and any proposals that reward the professionalism, experience and commitment of the great majority of teachers in our schools? Will he confirm that there is support for his proposals among trade unions, and would he contrast the opposition on the Conservative side of the House to strike action with the ambiguous attitude shown by Opposition Members?

Mr Clarke: Three trade unions are clearly campaigning for a review body to be established and I think that two others are near to that decision, so I confirm that there is obviously wide support among the teachers' trade unions as well as among hon. Members such as my hon. Friend for the proposition that we should move to a review body and away from strike action. I am glad to hear that my

hon. Friend shares my confidence that this will raise morale among the profession in Taunton, and that is a good background for discussing the rather difficult problems of reorganisation in and around his constituency of which I and my colleagues are now seized.

Mr. Dennis Skinner: Is the Secretary of State aware that one of the basic freedoms of people who have to work for a living and are subject to exploitation is the right to withdraw labour at all times? In view of what the Government have had to say in the past about ballots, will he give a guarantee that every single member of the teaching unions will be given an opportunity to ballot for or against the proposal? Have we not come to a sorry state of affairs when a Government elected in 1979 based upon entrepreneurialism, the marketplace and the highest bidder and against incomes policies have now resorted to a big idea in education which means a wages policy for teachers?

Mr. Clarke: The hon. Gentleman has the undoubted right in this country to persuade as many groups as he can to go on strike for whatever reason they wish, and he frequently exercises that right. I do not believe that in future he will persuade teachers to look again with any favour on strike action on pay terms and conditions because the great bulk of teachers will be attracted by what I have proposed. I have said that I am ready to meet leaders of the trade unions if they want to discuss my proposal. How the trade unions consult their own members is a matter for them. Perhaps the hon. Gentleman should address himself to the activists in the National Union of Teachers, who I do not think are in a majority in the NUT, who might wish to carry forward the argument as he does.

Mr. Patrick Nicholls: The skill and dedication that I see among teachers in the maintained sector in my constituency is light years away from the performance that we have heard from the hon. Member for Blackburn (Mr. Straw) today. Does my right hon. and learned Friend find it as depressing as I do that, at a time when we should be welcoming the fact that the Government have set up a review body which is not cash-limited and when the hon. Gentleman should have been thinking about the rights of children, he has only been able to proclaim the rights of strikers? Does not that say far more about the quality of the Labour party than relaunches of red roses?

Mr. Clarke: I say quite candidly to my hon. Friend that I am surprised that the official Opposition did not come out in support of the idea of a review body. I realise that it would have put the hon. Member for Blackburn in something of a spot, but the fact that he could not bring himself to support it I find genuinely surprising. I agree that to hear the hon. Gentleman getting back on to the old trail of demanding the right to strike for teachers will go down badly with teachers in my hon. Friend's constituency as I am sure it will across the country.

Mr. Richard Holt: My right hon. and learned Friend will know that, way back, I spent many years in negotiations and I welcome his statement today lifting the status of teachers out of the cauldron that we once were in. I am sure that all parents and all the many decent teachers in Britain will applaud this measure, which will lead to a professional status which will help to remove


those elements in the teaching profession which came to the surface from the Cleveland contingent at the conference down on the south coast recently. We hope that the new pay review body will have a status so that no longer will we have such people in teaching and so that teachers can be rewarded properly for their efforts in their dedication to our children.

Mr. Clarke: I agree with my hon. Friend's sentiments. I cannot help recalling that he and I have not always been in total agreement on industrial relations matters, so I am glad to hear that we are in agreement on today's proposal. Like him, I recall that, when Burnham was finally abolished, no one lamented its going, either from the trade union side or the employer side, and certainly not within the Government or among the general public. In the last 20 years of Burnham committee negotiations, a negotiated settlement was reached on only three occasions. It was a recipe for conflict. What we are proposing today is a recipe for harmony and greatly improved professional status for the teachers in our schools in the future.

Mrs. Rosie Barnes: I welcome the commitment to a well qualified and well paid leaching force along with the establishment of an independent review body. I firmly believe that there is no better formula for improving education in Britain than raising the status of teachers and improving their pay. Does the Secretary of State envisage a move towards more decentralised levels of pay within the context of the new review body?

Mr. Clarke: It is obviously an advantage of being in a small party to be able to come to conclusions and to be in no way mealy-mouthed about support for the idea of a review body, and I am grateful for the hon. Lady's support. We already have a lot of flexibility and, as I have said, I hope that the review body will build on that. As a result of the IAC's recommendations, local authorities, governors and schoolteachers have a large number of incentive payments and discretionary scale payments to consider at local level.
I believe that it is right that the review body should set the right professional framework nationally and that there should then be the maximum flexibility to reflect local labour conditions, to deal with particular difficulties in recruitment in particular subjects, and to reward most particularly those teachers whose classroom performance is outstanding. All that is already there, and I hope that the review body will build on that basis.

Mrs. Edwina Currie: Is the Secretary of State aware that already this afternoon six out of seven teachers' unions have said that they welcome the excellent reform that he has announced, and that some 400,000 teachers now belong to the main teaching unions which are rejecting the strike weapon? Will he particularly recognise the long-standing work of the Derby-based Professional Association of Teachers, which has long campaigned on the two principles that teachers are professionals and that the right to strike is absolutely wrong and is a weapon that should never be used in the classroom?

Mr. Clarke: I am grateful to my hon. Friend for bringing me the good news of this rapid response, but it is of the order that I predicted. I certainly share her confidence that the Professional Association of Teachers, with its general secretary, Peter Dawson, which has its

headquarters in Derby, will be wholeheartedly behind what we propose. Everything that we have said is in line with the views about the professional status of teachers to which those who join the PAT have always particularly committed themselves.

Mr. Bob Cryer: Is not the net effect of the Minister's statement to impose wage settlements on teachers? If teachers have this professional quality, are they not entitled to make a judgment about what is offered to them and to enter into genuine negotiations? Will he accept that teachers, like anybody else, only contemplate strike action as a means of last resort, like the nurses in the national health service who were pushed against their will to go on strike because it was the only alternative? The teachers have been often pushed into that position by the Government's attack on education but have declined to go on strike.
Can the Minister state unequivocally that that alternative will not be subject to any qualifications if, in the judgment of teachers, that is the point of last resort into which they have been pushed by an intransigent and anti-education Government?

Mr. Clarke: On the question of the Government imposing pay settlements, I remind the hon. Gentleman that in Committee the hon. Member for Blackburn (Mr. Straw) said:
We accept, in principle, that the Secretary of State should have the power to propose the final settlement."—[Official Report, Standing Committee D, 24 January 1991; c. 208.]
As the Government face the fare and pay the bill, the Government have to have that power in the last resort.
I am saying today that we will determine teachers' pay in the light of the independent recommendations of the review body and depart from them only if there are clear and compelling reasons to the contrary. That is a method which has served other professions extremely well. I think that it will be attractive to teachers and, as I have already said, I think that it is far more attractive than the hon. Member for Blackburn's invocation once more of the right to strike.

Mr. Kenneth Hind: Does my right hon. and learned Friend agree that when he visits schools, as I do, the teachers make the point that the one thing that they want is that raising the status of teachers should be placed alongside the importance of teaching children? What my right hon. and learned Friend has done today is to give them the very thing that they want—respect from the public and, as a profession, the understanding of Government. In the light of that, will my right hon. Friend confirm that, contrary to what one would expect from listening objectively to the comments that have been made, the one thing that he is not doing is to remove the right of teachers to strike if they ultimately feel that that is the only thing left open to them in order to register a protest against the review body?

Mr. Clarke: First, I entirely share my hon. Friend's sentiments. The position that he outlines parallels my experience with the vast majority of teachers that I have met. Secondly, the Government have put forward the review body proposal and intend to proceed on the basis that teachers will not strike about pay, terms and conditions and other matters within the review body's remit. It is an important principle of review bodies that


they advise the Government on the determination of pay of those key professions in the public services which do not take strike action against pupils, patients and so on.
If strike action were contemplated the situation might change, but I put forward this proposal in the confident expectation, which my hon. Friend shares, that teachers will now regard strike action against pupils as a thing of the past and will proceed to a much more sensible basis for determining the pay of a learned profession.

Mr. Roy Beggs: No doubt the proposals will shortly apply to Northern Ireland. I welcome the clear recognition by the Government of the professionalism of teachers. However, as a former teacher I must tell the Secretary of State that sheer frustration with poor pay and conditions, increasing work loads, generally poor morale and low expectancy of promotion occasionally pushes teachers into taking industrial action. I hope that trade unions will take the opportunity to put to their members the fact that the independent review body should be an acceptable way forward. Teachers should be consulted and their views should be communicated to the Minister before a final decision is taken.

Mr. Clarke: I should make it clear that my statement refers to England and Wales and that my right hon. Friend the Secretary of State for Scotland has no present intention to proceed in this way. The situation in Northern Ireland on teachers' pay has always been somewhat detached from that in England and Wales. My right hon. Friend the Secretary of State for Northern Ireland also has no present intention to proceed in this way, but, like my right hon. Friend the Secretary of State for Scotland, he will no doubt observe the situation in England and keep his arrangements under review.
I propose to offer discussions to teachers' trade unions on the Government's proposal. We shall shortly introduce the Bill and will listen to the unions' views, but I expect that the unions will be driven on by the pressure of their members to accept this offer of professional status and a much improved method of determining their future pay.

Several Hon. Members: rose—

Mr. Speaker: Order. Would hon. Members who are rising put brief questions and not repeat previous questions? If they do that, I shall do my best to get them all in.

Mr. Harry Greenway: Is my right hon. and learned Friend aware that the most union-minded teachers that I know—and I know thousands—including my former teaching colleague the general secretary of the National Association of Schoolmasters/Union of Women Teachers, have wanted such a pay review body for a long time? They will find fulfilment in my right hon. and learned Friend's announcement. Will he confirm that, as they move into line on pay bargaining with doctors, the judiciary and others, we can expect to see highly successful teachers properly paid in the same way as highly successful doctors and others who do no more than good teachers?

Mr. Clarke: As my hon. Friend says, the general secretary of the National Association of Schoolmasters/ Union of Women Teachers has been campaigning for a review body, so presumably his union will welcome my

announcement. The review body will be independent and I cannot anticipate its recommendations. It will be told to have regard to affordability and the other considerations that I mentioned.
In the past 10 years, during the lifetime of the Government, groups such as doctors and nurses who are covered by review bodies have received a bigger percentage increase in earnings than any other group of public sector workers. They have received a bigger percentage increase than the police or teachers and a much bigger increase than many other groups. That will not be discouraging news in terms of the general career expectations of teachers. Professional status and independent advice on pay levels will recognise the true worth of teachers in our society.

Mr. John Marshall: I assure my right hon. and learned Friend that his statement will be warmly welcomed in the London borough of Barnet, where schools regularly produce the best A-level results of any local authority. My right hon. and learned Friend spoke about the review body having reference to local labour markets. Can he assure us that the review body will look closely at high housing costs in the south-east and at the need to give special pay incentives to teachers of shortage subjects?

Mr. Clarke: I am sure that employers will offer the review body advice on that and on many other matters. It is an important matter in Barnet and over wide areas of the south-east. I hope that the review body will build upon the progress that the IAC has made in injecting much more flexibility into the pay offered by individual employers to teachers of shortage subjects or to teachers in places where high housing costs make it difficult to recruit.

Mr. George Walden: Does my right hon. and learned Friend agree that it would be surprising if teachers did not warmly accept his proposals, because they will tend to do extremely well out of them? That is because I would be surprised if the review body did not recommend a considerable increase for teachers in order to meet the criteria that my right hon. and learned Friend spelled out —recruitment, retention, motivation and above all adequate calibre. Everyone knows that there is a problem about the calibre of teachers, and we are seeing its effects in spelling and reading and, most recently, in the scandalous case of Culloden school, which case I am glad to say my right hon. and learned Friend has taken up.

Mr. Clarke: I agree that we certainly need advice on the necessary levels of payment to recruit, retain and motivate people of the right quality in our teaching profession. I hope that the review body will adhere to that principle. I shall be enjoining sensible constraint on the review body when submitting evidence on behalf of the Government. I have repeatedly tried to do that when submitting evidence to review bodies advising on the pay of doctors, dentists, nurses and midwives.
We await the review body's judgment about what is a sensible and affordable level of settlement for next year. However, my hon. Friend may underestimate the power of persuasion of the hon. Member for Blackburn. Perhaps teachers will turn away from what my hon. Friend thinks is attractive and decide that the right to go on strike and to take action affecting their pupils is an important principle about which the Labour party will remind them and take them back to the old flags.

Mr. Derek Fatchett: Plainly, the Secretary of State is simply engaging in empty rhetoric about industrial action. It is clear from his answers that he is not imposing a precondition of no industrial action. Will he confirm that the Bill will contain no provision that teachers will not be able to take industrial action? If he confirms that he does not intend to remove from teachers the right to strike, it is clear that all he has said about industrial action is just empty rhetoric to please the right wing of the Conservative party.
Will he also tell us whether his Second Reading rhetoric about the need for flexibility on the part of individual local education authorities has now been dropped? All the arguments that made up most of his Second Reading speech were that individual authorities should have the right to bargain separately with trade unions. Will he confirm that he has now dropped that further piece of right-wing ideology?
Finally, the Secretary of State speaks about improving the status of teachers and their confidence in the Government. After this mess, teachers will have little confidence in the Government, because for six weeks in Committee and on Second Reading we were told by Ministers that this was the best way to make progress in improving teachers' pay and conditions. Ministers did not know what they were saying or were wrong or simply did not have confidence in their own views. Therefore, how can teachers have confidence in what Ministers say? It is a shambles and a mess, and it shows that the Government are simply not fit to govern.

Mr. Clarke: Here we are, half an hour later, and the official Opposition spokesman still cannot tell us whether the Labour party is in favour of a review body for teachers and does not answer questions about it. I advise the hon. Gentleman to go away and contemplate these matters and come back and give us a considered view.

Mr. Fatchett: The Secretary of State keeps going on about strike action.

Mr. Clarke: The hon. Members who go on and on and on about strike action are the hon. Members for Blackburn and for Leeds, Central (Mr. Fatchett), who are sitting together on the Opposition Front Bench, and two of their Back Benchers who over the past half-hour have made an issue of the right to industrial action.
The review body is being set up on the same basis as other review bodies, that those to whom they apply, in this case teachers, will not take strike action over pay, terms and conditions. That does not need to be in the Bill. If teachers accept the advice of the Labour party and insist on the right to take strike action over pay, we shall need to review the remit of the interim advisory committee. [Interruption.] Labour Front-Bench spokesmen will make a serious mistake if they advise teachers on such action. It would be a serious misjudgment to try to get teachers to support the right to strike and turn down a review body

—[Interruption.] Usually, I understand the barracking of the hon. Member for Blackburn, but he is confused today. Rather than ranting from a sedentary position, he should go away and decide whether he is in favour of or against a review body, and whether he thinks that teachers should insist on the right to strike or whether they should abandon that stance. I would then listen to more of the Opposition's hectoring.
I have already said that local education authorities will have a great deal of flexibility. We will not allow them, as a whole, to opt out of the review body system, because that would enable a few left-wing authorities under the influence of the Labour party to destabilise the system by returning to traditional methods of setting pay, which we do not want.
Grant-maintained schools will have the right to enter into their own arrangements, exactly as was proposed in our previous Bill. It has become obvious during recent months that the managerial level of grant-maintained schools is the right level to determine the details of pay and conditions, just as grant-maintained status is the right way to determine the overall policy of a school. That is where we will place the managerial discretion—which, surprisingly, the hon. Gentleman appears to favour. I invite him to go away and address the key policy issue and perhaps let me know tomorrow whether the Labour party is or is not in favour of a review body, and whether it supports strike action by teachers or whether, overnight, it might come to think that it is rather a bad idea.

Several Hon. Members: rose—

Mr. Speaker: I say to the hon. Members for Isle of Wight (Mr. Field) and for Eastbourne (Mr. Bellotti), who rose after I made my announcement, that they might try their luck at education questions on Tuesday.

BILL PRESENTED

MENTAL HEALTH (DETENTION) (SCOTLAND)

Sir Russell Johnston presented a Bill to amend the Mental Health (Scotland) Act 1984 with respect to short term detention of patients in hospital and the determination of applications for admission to hospital: And the same was read the First time; and ordered to be read a Second time on Friday 22 April and to be printed. [Bill 134.]

Statutory Instruments, &c.

Mr. Speaker: With the leave of the House, I shall put together the two motions relating to statutory instruments.

Ordered,
That the draft Civic Government (Scotland) Act 1982 (Licensing of Houses in Multiple Occupation) Order 1991 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Data Protection Registration Fee Order 1991 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Boswell.]

River Safety

Mr. John Bowis: I beg to move,
That leave be given to bring in a Bill to require minimum standards of visibility from the steering position of passenger launches plying on rivers and other inland waterways; to require the fitting of discotheque noise limiting devices in such launches; to make provision for signalling systems for traffic control in certain rivers; and for connected purposes.
The subject of river safety inevitably makes us think of the tragedy surrounding the Marchioness and the lives lost. I wish to go back beyond that date and show that the lessons that should have been learnt were not learnt, and that lessons must be learnt from the Marchioness tragedy to ensure the future safety of passengers on our rivers and waterways.
In 1927, 40 people lost their lives in Sydney harbour in a collision between the Tahiti and the Greycliff. The inquiry into the accident concluded that the Greycliff had not seen the Tahiti coming up on it from behind. The inquiry said that it was
incumbent on the proper authorities to impress upon masters of all vessels the obligation of keeping an effective lookout astern as well as ahead and abeam. As a first and important step, the owners of vessels should be compelled, in all cases where adequate structural facilities for enabling such a lookout to be kept do not exist, to provide them without loss of time.
That was 1927. It is now 1991, and we are just getting round to doing that.
In 1981, the Bowtrader and the Hurlingham collided. The Hurlingham did not realise that the dredger was behind it, and altered course across its bows. The inquiry said that there was no adequate view aft from the Hurlingham. The Hurlingham was a similar structure to the Marchioness.
In 1983, the Bowbelle and the Pride of Greenwich collided. A subsequent report said that the
Pride of Greenwich's visibility aft by night was virtually non-existent.
Again in 1983, the Shell Distributor and the New Southern Belle collided. The report said that the tanker saw the passenger vessel and tried to signal on VHF, but there was no reply. It tried its whistle, but it was not heard because the music on the vessel was too loud. The report also said that there was no rear vision.
In 1989, the Bowbelle and the Marchioness collided with the loss of 51 lives. It is clear from the report of the inquiry into that accident that, again, a major factor was that there was no adequate rear vision from the Marchioness. A shouted warning from the dredger was heard by some of the people on the deck, but not in the wheelhouse. One of the major reasons for that was the disco music on board.
The two lessons that we must learn from that and previous accidents is that something must be done, first, about visibility and, secondly, about noise, and my Bill seeks to deal with both. It is clear that when a skipper has to leave the wheelhouse and go to the ship's side, climb a ladder or raise a hatch in order to see astern, that is not a proper lookout. It is recommended that regulations be introduced governing that aspect of passenger launch construction for new vessels, and that the regulations should also apply to existing vessels where the visibility astern does not reach a minimum safety standard. That

must be right. I know that the authorities are discussing the problem, but that is not adequate. We need to introduce regulations.
I am aware that closed-circuit television is being considered as a means to solve the problem, but I am not convinced that at night that would be adequate to see that nothing was coming up behind. The report recommends that a lookout be placed if the structure is not right, but I should prefer the structure on the vessels to be put right.
As we sit in the Library on a summer evening, we are well aware of the noise of the disco music on boats as they pass. That may be irritating to us, but it is highly dangerous to the people on board those vessels. Even when the noise-limiting device is, in theory, adequate, there are ways to bypass and cut off those devices. We need regulations to ensure that that cannot happen.
The noise on board a vessel can interfere with the ability of the skipper to hear a VHF signal. It can also affect his concentration. There is plenty of research showing that noise affects concentration during long periods of work, to the detriment of performance. There must be a noise-limiting device. Obviously, there must be a cut-out device so that if there is time—which, sadly, there was not on the Marchioness—to give a warning to passengers, the music can be cut off in the passenger area so that passengers can hear the warning from the skipper. Those are the two major lessons that have not yet been learnt from tragic accidents—not only the Marchioness, but the other accidents that I cited.
We must also deal with the question of the bridges on the river Thames. Their alignment does not always make navigation simple. Indeed, the tides do not always make navigation simple. There are large vessels in the area above the Tower of London, and they can cause problems for smaller vessels. In theory, byelaw 19 of the Port of London authority gives some priority to larger vessels above the tower because of their restricted freedom to manoeuvre. However, that is not adequate, because dredgers and other vessels, including tugs towing barges, are not simply restricted in their freedom to manoeuvre, but have no freedom to manoeuvre other than within narrow limits. In many cases they cannot reduce speed—indeed, they must keep up speed for safety reasons so that they do not lose steerage way when approaching a bridge.
My third measure is to ensure that there is a system of traffic lights on bridges so that smaller vessels know when larger vessels are coming through. I know that experiments are being carried out and I hope that the Bill will ensure that lights are made mandatory on all bridges where such a risk is deemed possible.
My last point concerns the publication of reports following disasters. It is now almost two years since the Marchioness sank with the loss of 51 lives, yet the full report cannot yet be published. It cannot be debated in the House or by the public because of the Merchant Shipping (Accident Investigation) Regulations 1989, which are sometimes ambiguous. One of those regulations says:
Where the Report … indicates that there may have been a breach of the law and that prosecution of the suspected offender should be considered, the Report shall not be published until either prosecution, including any appeal, has been concluded or it has been decided not to prosecute.
That is not an adequate description of the purpose of the regulations. Another regulation says:
The fundamental purpose of investigating an accident under these Regulations is to determine its circumstances and the causes with the aim of improving the safety of life at sea


and the avoidance of accidents in the future. It is not the purpose to apportion liability, nor, except so far as is necessary to achieve the fundamental purpose, to apportion blame".
Reports should not remain secret, hidden and unavailable for public discussion unless it can be shown that publication of part of a report or, as happens occasionally, a whole report would damage a defence case. The onus should be on someone wishing to prove that such damage would occur.
It is now past Easter and the crowds are beginning to come out on to our river. We hope that people will enjoy their river trips, but I want to ensure that those trips are safe as well as enjoyable. The lessons of the past have not always been learnt. We must learn from previous tragedies. The lesson is that if ships can see and be seen, hear and be heard, notice and be noticed, they are less likely to have, or cause, an accident.

Question put and agreed to.

Bill ordered to be brought in by Mr. John, Bowis, Mr. Tony Banks, Mrs. Rosie Barnes, Mr. Gerald Bowden, Mr. Matthew Carrington, Mr. John Cartwright, Mr. Dudley Fishburn, Miss Kate Hoey, Mr. Simon Hughes, Mr. Toby Jessel and Mr. Ron Leighton.

RIVER SAFETY

Mr. John Bowis accordingly presented a Bill to require minimum standards of visibility from the steering position of passenger launches plying on rivers and other inland waterways; to require the fitting of discotheque noise limiting devices in such launches; to make provision for signalling systems for traffic control in certain rivers; and for connected purposes: And the same was read the First time; and ordered to be read a Second time upon Friday 3 May and to be printed. [Bill 135.]

Opposition Day

[10TH ALLOTTED DAY]

Health Service and Community Care

Mr. Deputy Speaker (Mr. Harold Walker): I have to inform the House that Mr. Speaker has selected the amendment standing in the name of the Prime Minister. He has also asked me to tell the House that he intends to impose a ten-minute limit on speeches between 7 and 9 pm.

Mr. Robin Cook: I beg to move,
That this House is disturbed that, in the past financial year, underfunding of the health service adversely affected patient care by compelling hospitals to cancel more operations and close more beds than even the previous financial crisis of 1987–88; condemns the persistence of Her Majestys' Government in forcing on the National Health Service a market driven system of health care against the opinion of the overwhelming majority of the people who work in the health service and of the people who use the National Health Service; records its concern at the growing evidence that the system of patients following contracts results in less choice for patients of where to be treated and restrictions in the treatments available to them; regrets the two year delay in the introduction of the Community Care programme which should have taken effect this month; is alarmed at the serious threat to social service provision as a result of the crisis in local government finance created by Her Majesty's Government; and calls upon Her Majesty's Government for urgent action to tackle the growing gap between income support levels and charges for residential care.
Listening to the previous exchanges with the right hon. and learned Member for Rushcliffe (Mr. Clarke) I had a sense of déjà vu from our debates on this topic last year. I recall that in one of those debates I predicted that the last place the right hon. and learned Gentleman would want to be in April 1991 would be the Department of Health, where he would have to carry the can for what he had thought up. I said that he would rather be at any Ministry but Richmond terrace. I think that we can begin this debate by chalking up another accurate prediction. The right hon. and learned Gentleman is now bringing his customary tact and delicacy to the nation's classrooms. No doubt if he is ever asked about those two years in Richmond terrace he already has an answer handy: "I was never registered at that address: I stayed with a lady across the road." [Laughter]. In truth I must tell my hon. Friends that the White Paper was indeed written by a lady across the road, in Downing Street.
In the right hon. and learned Gentleman's place we have a different Secretary of State, complete with his own alibi—

Mr. Terry Lewis: Not for long.

Mr. Cook: My hon. Friend should be more charitable at the start of a debate.
While the changes in the NHS were germinating, the right hon. Gentleman was at the Department of the Environment, thinking up the poll tax. The claims that he is about to make for the NHS changes over which he now presides must be weighed against the wisdom that he showed in his predictions for the poll tax, including his observation that
Those who argue that the poll tax is impracticable are protesting too much".


I have to warn the Secretary of State that those of us who, years ago, warned that the poll tax was impractical are now warning him that these changes to the NHS will deeply damage it. And on the evidence of the poll tax we have a better track record of getting our predictions right.
We do not need to look as far as the poll tax to see how widely wrong the Government's predictions are. Two key predictions about health issues since 1987 by the Secretary of State's predecessors have proved wrong on a scale that would be comic if it were not so serious. First, there was the abolition of free eye tests. The right hon. Gentleman's predecessor simply refused to believe us when we told him that if he stopped paying for free eye tests opticians would start charging for them. He assured the House that opticians would compete against each other to do it for free. In November 1988 he said:
the charge for the eye test will steadily disappear … that is my strong personal opinion."—[Official Report, 1 November 1988; Vol. 139, c. 927.]
Today, almost every optician charges between £10 and £17 for an eye test.
When does the Secretary of State expect charges for the eye test steadily to disappear? I should be fascinated to hear his answer. I will happily give way to him so as to hear it. If he does not expect charges for eye tests to disappear, how can he expect us to believe the Government's predictions of what the magic of the market will do to the NHS when we know what it has done to eye tests?
The second issue on which the Government were widely wrong was that of tax relief for private medical insurance for pensioners—the first proposal in the White Paper to be put into practice. The White Paper made it clear that the purpose of granting tax relief was to encourage the take-up of private insurance by pensioners. That is one thing that tax relief has not done. With a heavy heart, I must report to the House that BUPA has made a loss on its scheme for private insurance for pensioners. It has spent £3 million gearing up for a new era of BUPA pensioners, and it did not get enough new subscribers even to cover its start-up costs. All that has happened has been a windfall gain for all who already had private insurance. Thanks to this bit of dogma, we are now spending £50 million a year for no increase in the take-up of private insurance, without an extra penny of it going into the NHS wards for pensioners. The Government amendment speaks of "improved value for money". Where is the improved value for money in this expenditure of £50 million?
Against this background of spectacular misjudgments, we come to the right hon. Gentleman's predictions about the changes that the Government are levering into place this month in the health service. There are design flaws in the new system that are already evident—most of them predicted by us. But some things have occurred that we did not predict. I have to confess that I did not predict that Lord Rayner would emerge as a self-confessed critic of the changes. After all, he is the Government's favourite business man, brought in by the previous Prime Minister to bring business common sense to the public sector. Last month he brought his common sense to bear on the changes to the NHS and he said:
The whole thing to me was a total nightmare. There is no way this business"—
that is, Marks and Spencer—
could turn itself upside down overnight—There is no way we could do it without proper experiment and evaluation.

My only regret is that Lord Rayner is such a late entrant among the critics of the scheme, but many of us criticised it as it went through the House and we made a number of predictions which are all now coming true.
We predicted that there would be less choice for patients as to where they are treated. The Government promised that money would follow patients; we predicted that patients would follow contracts. Earlier this week I received a letter from a lady who had returned from seeing her GP in Kent. She wrote to me to say that she was, "Lost for words." She has been attending Guy's hospital since 1979. Last week she was told that she must stop attending Guy's hospital—she would no longer be under the care of the consultant who had been looking after her for 12 years —and transfer to the hospital in Kent that has the contract for that condition. The Government's amendment talks about more responsiveness to people's wishes. Where is the responsiveness to the patient's wishes in that case? I ask the Secretary of State the same question that that lady asked me:
Was it the intention that the NHS changes should cause my care to suffer?
Yesterday was released an internal document from Wandsworth health authority. It is 18 pages of guidance on how to handle patients who want to go to different hospitals from the one where the block contracts have been placed. Outside the Conservative party's manifestos, I have never read a document of such sustained cynicism. It is blunt. It states that it will have to "reduce to the minimum" the number of patients outside block contracts. Obligingly, the document admits:
Patient choice, a cornerstone of the stated benefits of the reorganisation, may be reduced … This has its implications politically with respect to … public relations.
How did Wandsworth propose to handle those political implications and public relations problems? It resolved to resolve them by keeping the patient in the dark. Its advice to GPs is: "Never say no." Always "defer" or "redirect" a referral. Keep patients out of the discussion as to where they go.
In most instances the patient should remain unaware of the process of the purchaser/provider discussion.
How does the Secretary of State square that squalid manual with the promise that the White Paper would put the needs of patients first?

Mr. Phillip Oppenheim: I thank the hon. Gentleman for giving way and I hope that he will forgive me for intervening so early in his speech, but his answer to my question will have a bearing on the credibility of the rest of his speech. The hon. Gentleman will be aware that not so long ago the hon. Member for Derby, South (Mrs. Beckett) said that any future Labour Government would have a number of spending priorities such as pensions and child benefit. Can he tell the House whether the NHS would be one of the priorities of a future Labour Government? Will he answer yes or no?

Mr. Cook: Yes. Only yesterday my hon. Friend the Member for Derby, South (Mrs. Beckett)—[HON. MEMBERS: "Yes or no?"] I said, "Yes." There is no point in the hon. Gentleman's repeating the question after he has heard the answer. Only yesterday my hon. Friend the Member for Derby, South and I sat on the same platform when we published our policy document for this year. It contained a whole section on spending commitments on the health service. We are committed to restoring the


underfunding of the health service under the present Government and fully funding pay awards—something that they have not done since 1983.

Several Hon. Members: rose—

Mr. Cook: I shall not give way, as I am answering the hon. Gentleman's question. The hon. Gentleman asked me a question. He cannot object if he does not like the answer.

Several Hon. Members: rose—

Mr. Cook: In the interests of the hon. Member for Amber Valley (Mr. Oppenheim) I must implore your assistance, Mr. Deputy Speaker, so that he gets the answer for which he has asked.
In that document we are committed to making sure that the year-on-year funding of the health service fully reflects the changes in demographic pressure that result in added claims on that health service. Our spending priorities for the health service are clearly stated. I know perfectly well why Conservative Members do not like the answer. They wanted a different answer that bears out their prejudices about our priorities rather than the reality of what we say.

Mr. Jerry Hayes: Will the hon. Gentleman give way?

Mr. Cook: No speech on health from this Dispatch Box is complete without an intervention from the hon. Member for Harlow (Mr. Hayes) so we might as well get it over with now.

Mr. Hayes: I am most grateful to the hon. Gentleman. I know that he wants to be helpful to my hon. Friend the Member for Amber Valley (Mr. Oppenheim). I have here the actual document on health that the Labour party published yesterday. Perhaps the House ought to hear what it says and then the hon. Gentleman can tell us a little about sustained cynicism. It states:
We will invest in the modernisation of our hospitals and tackle the backlog in maintenance and repairs—although we cannot expect to put it right overnight.

Mr. Cook: After that intervention I promise to let the hon. Gentleman in a second time. Let me explain to the hon. Gentleman, who appears to be unaware of these things, that the total maintenance budget for the national health service is some £500 million per annum and the total backlog that the Government have generated in a decade is £2,300 million. It is extraordinary that the hon. Gentleman believes that even the Labour party could attempt to put right overnight a £2,300 million backlog. I assure him that it may take us more than the first night.

Mr. Anthony Coombs: rose—

Mr. Andrew Mitchell: rose—

Mr. Cook: I shall not give way again. They have had two fair attempts and I have been generous to the hon. Gentlemen in pursuing their hares.

The Secretary of State for Health (Mr. William Waldegrave): The hon. Gentleman supports the party which was responsible for the only cut in real terms in a year in the history of the health service under the Government in which the right hon. Member for Blaenau Gwent (Mr. Foot) was a Cabinet Minister. We have a right to talk about cynicism when the hon. Member for Livingston (Mr. Cook) talks about spending pledges.

Mr. Cook: If the Secretary of State wants to tweak where people were in 1975 when the White Paper was approved, he should look at the record where he will find that I voted against those cuts. The record does not lie. I am sure that my hon. Friends will agree that if those Conservative Back Benchers who now tell us that they always opposed the poll tax had had the courage to vote for what they believe in, local goverment would not now be in crisis.
We also predicted that the changes would mean that less treatment would be available on the national health service. Lo, in the first week of the new system a woman from south-east Kent was refused sterilisation because her health authority would not pay for it. Nor will she be alone. Basildon and Thurrock carried out 303 vasectomies last year, whereas this year they plan to purchase 15. What has happened to choice for the people in those health districts?
Even before the changes were in place, North East Thames RHA took a covert decision not to pay for the removal of varicose veins. The Secretary of State's response to that was that it should be a matter for clinical judgment. With respect, it is precisely these changes that have stopped it being a matter of clinical judgment. The regional district manager of the North East Thames RHA stated:
Regional officers are presently preparing a list of procedures which unless there is an overriding clinical need may be deemed inappropriate to place on waiting lists".
This is an appropriate moment to say that at 3.30 pm today the Secretary of State released the latest figures for health service waiting lists. They are the highest in any September since records began. Moreover, they reached that peak even before the effects of the past winter in which hospital after hospital closed its doors for routine operations. What is most embarrassing for the right hon. Gentleman in those figures is not the number of patients waiting, but the number of patients treated in those six months. Afters years during which the Government told us that what was important was not the number of patients waiting but the number being treated, today's figures show a 3 per cent. reduction in in-patient levels.
The amendment tabled by the Secretary of State invites the House to congratulate the Government on having achieved a 25 per cent. increase in in-patient activity during the past 10 years. In the light of this afternoon's figures, perhaps it will be appropriate for you, Mr. Deputy Speaker, to accept a manuscript amendment to reduce that figure to 22 per cent.
I warn my colleagues that I suspect that we are about to see a major improvement in waiting lists. I suspect that they will go the way of the unemployment statistics, not because more people are coming off those lists but because fewer will get on. Before they are magicked away —

Mr. John Butterfill: rose—

Mr. Cook: I am asking a question.
Ministers sold us the scheme as a basis for widening patient choice. Will they now guarantee that every patient who was on a waiting list on 31 March will be treated for the procedure for which they were waiting and at the hospital for which they were waiting? It is a simple question, which is a fair test of whether the scheme puts patient choice first. I see that all three Ministers are attempting to avoid my eye.

Mr. Butterfill: rose—

Mr. John Marshall: rose—

Mr. Cook: I will give way only to a Minister because we are entitled to an answer. Will every patient who was on a waiting list on 31 March receive treatment in the hospital of his choice? I can catch your eye, Mr. Deputy Speaker, but I have difficulty in catching the eye of any of the Ministers.

Several Hon. Members: rose—

Mr. Cook: No, I shall not give way.
I am not surprised that the Ministers do not want to rise, because there has been a change in the language used to describe the reforms. Two years ago we were assured that the reforms would mean that money would follow the patients. Overnight, the Government had found the formula to end underfunding. I sat through successive debates with successive Conservative Back Benchers who were bubbling with enthusiasm about the fact that their hospitals would be in clover because they did more work than the others. They believed that because money would follow patients, more work meant more money. Oddly, we never heard from the Back Bencher whose hospital did less work and would therefore lose money which would be gained by others.
I issue a warning to those Back Benchers, some of whom I recognise here. I do not know whether they have noticed the change in the language, but "Money following the patient" is no longer a buzz phrase. It is a little while since I heard a Minister use it. I shall listen with excitement to see whether a Minister uses it today. The change in the language has been subtle. We are now told that the benefit of the reforms is that they make explicit what the health service can afford. I shall make explicit what that means —it means a tighter system of rationing health care. Health care will now be rationed by the business men with whom the Government have stuffed the health authorities and who do not represent anyone in the local community but are charged with deciding who in that community receives care.

Mr. Butterfill: The hon. Gentleman talks about the resources available and the effect that they may have on waiting lists, but he should remember that waiting lists have been reduced by 6 per cent. under this Government but increased by 48 per cent. under the previous Labour Government.

Mr. Cook: I refer the hon. Gentleman to the Government's figures produced at 3.30 pm this afternoon. If he cares to examine the figures released for last September, he will find that there has never been a September under this Government in which waiting lists have failed to be higher than those for any September under the previous Government. Now, for the first time, Britain has a million people on waiting lists.
I make a third prediction about changes. I predict that they will make the health service less fair. If health care is put on the market, the patients who will come first will not be those most in need, but those who bring the hospital the most money. I could not have hoped for a clearer warning of that danger than the decision taken by Christie hospital in Manchester—on the eve of the changes—to sell a fast-track admission to patients from health authorities that pay more. Health authorities that pay more will get

patients in within two weeks, whereas others will get patients in after six weeks. I cannot think of anything more repugnant than a two-tier standard of admissions for patients who are in an advanced stage of cancer, which strikes more thoroughly at the principle of the NHS which is that priority goes to those who are most in need of treatment, not to those who have paid the most.
In my naivety I imagined that the Secretary of State would be embarrassed by the revolution. He was not; he welcomed the scheme. However, the scheme was too much even for the Daily Express which, on the day that the changes came into effect, reported the Secretary of State as saying that this was
what the new reforms of the Health Service 'are all about'.
It continued:
Then they are a disgrace … Maybe the Labour Party was telling the truth after all. Perhaps the NHS is unsafe in the Tories' hands.
My final prediction and warning —

Mr. Simon Hughes: So far, I agree with and support all that the hon. Gentleman has said, but I wish to amplify his expression of concern. I am the Member of Parliament for the constituency that contains Guy's hospital. It is not only people from outside the South East Thames RHA district who are becoming increasingly concerned and have been told that they could not come to that hospital for treatment. Others have been told to return equipment on which they rely and without which they cannot manage. People from within the district are also increasingly fearful that they will be kept waiting on trolleys in corridors, as the hon. Gentleman saw when he came with me to King's College hospital. They are also worried about getting home because the ambulance does not come and about waiting for treatment that they traditionally received at their hospital, but which they might not now receive because some have the advantage of buying whereas they, as local patients, are not expected to pay.

Mr. Cook: I am grateful to the hon. Gentleman for supporting my case. It is ironic that not only do I speak in this debate for the people who have supported my party and not only does the hon. Gentleman speak for the people who supported his party but between us we speak for most of the people who supported the Conservative party and who did not want these changes either.
Our final prediction is that these changes will make the health service less efficient. They have already diverted colossal resources into more managers, more clerks and more computers to run the marathon paperchase that it demands. There is a debate between the British Medical Association and the Health Service Journal on whether the number of new management jobs advertised is 300 a month or only 130 a month. It is common ground between both participants in the debate that we are pouring millions of extra pounds into administration at the very time when we are closing thousands of beds because we cannot afford to keep them open.
Of course, new managers need new salaries. Just like privatisation, opting out has released a tidal wave of gravy over top management. The chief executive of Guy's now gets £5,000 a year more to run Guy's than Duncan Nichol receives to run the whole NHS. It is common gossip in the health service that the financial package for the chief executive of Guy's includes a free car for the use of his


wife. The total cost of pay and perks to senior management at Guy's is equivalent to the cost of running three wards at that hospital.

Mr. Simon Hughes: One ward was closed.

Mr. Cook: As the hon. Gentleman said, one ward was closed in the first week of the changes. Whatever happened to "improved value for money" when those salaries were negotiated?
Another type of inefficiency is starting to emerge from the changes. The theory was that we would get better value for money because health authorities would shop around for contracts while hospitals would compete with each other for business. Like all fairy tales, this would have a happy ending—competition would drive down unit costs.
Of course, real life is much more complicated. After being told to balance the books or go bankrupt, hospitals have quickly discovered that the quickest way that they can do that is to do less work for the money that they were getting before. The district general manager of Tower Hamlets health authority has complained publicly that the Royal London insists on a cut of 3 per cent. in activity for the same amount of money and he is still arguing with St. Bartholomew's hospital which wants a cut of 15 per cent. in activity. He has gone on record as saying that every London hospital except those in Bloomsbury wants to cut its work load. That is a rational response because the Secretary of State has changed the objective from meeting patient needs to balancing the books. The point of markets is not to satisfy needs but to achieve equilibrium. The problem for the Secretary of State is that some hospitals want to achieve that equilibrium at lower levels of activity.

Mr. Peter Thurnham: rose—

Mr. Cook: I shall not give way again. As you said, Mr. Deputy Speaker, many hon. Members wish to speak.
Is the Secretary of State prepared to measure the success of those trusts that opted out by the simple test of whether they do more or less work on NHS patients? There is, of course, a counterpoint to all the energy and all the inventions applied by those managers to the changes this month in the health service. This is also the month that was to witness the new programme of community care. In sharp contrast with the way in which Conservative Members plough ahead with the changes in the NHS, they have shelved the package of community care for two years, yet the amendment invites us to congratulate the Government on achieving it by April 1993.
Last July, the Secretary of State's predecessor said that the Government had to shelve the community care package for two years because of problems with the poll tax—another of the little impracticalities that he had overlooked. No doubt Ministers will tell us that the two-year delay is not a standstill in community care. That is right. Thanks to the poll tax, local government is in financial crisis. All over Britain, community care is not at a standstill; it is in retreat and is under pressure to make cuts.
Last month, the directors of social services published a survey on the state of social service budgets. Half those budgets ended up underfunded and in deficit. One third of those authorities expect to make reductions in their budgets this year. I have a list of cuts by one metropolitan authority that is cutting £2·5 million from its budget. Those cuts include cuts in home helps, meals on wheels,

transport for the disabled and grants for voluntary agencies. The only thing going up are charges to the clients of those authorities.

Mr. Keith Mans: Labour authorities.

Mr. Cook: Only two weeks ago, the hon. Gentleman's colleagues in government, whom I presume he supports, imposed a poll tax cap on five social service authorities, three of them Labour and two Conservative. A third Conservative authority escaped only by making dramatic cuts the night before. These pressures are not imposed just on profligate high-spending authorities; they apply across authorities of both political colours and to local authorities that are honestly and decently trying to meet the rising tide of demand in their communities.
The authority to which I referred plans to raise £1 million more in charges from its elderly and disabled residents by doubling the charges for home helps. Most clients were exempt before; none will be exempt now. Two weeks ago, the Minister for Health said that local authorities should become much more comfortable with the idea of charging clients. I am uncomfortable with the idea of charging even the poorest pensioner for the home help whom she needs in order to stay in her home.
The worst victims of the two-year delay are the elderly who cannot stay in their home, who were encouraged by the Government to go into private residential care, who were put into private residential care by managers who could not find a place for them in hospitals and who now find that the Government will not pay for their keep. On 1 April, their income was uprated by 3 per cent.—one third of the inflation rate and less than one third of the increase in charges for residential care.
Two months ago, the National Association of Citizens Advice Bureaux published a report rich in examples of their caseloads of people who could not pay their bills and of cases showing the emotional distress, personal indignity and financial hardship caused by that trap. There is the woman of 88 who cannot buy batteries for her hearing aid because her personal allowance is swallowed up in paying charges. There is the man of 78 with Parkinson's disease and suffering incontinence who cannot buy new trousers because all his money has gone on the charges. There is the distress to the relatives of the two women pensioners on income support who, out of a weekly income of £75 between them, must find £15 a week to meet the gap in their mother's residential care charges.
There is no need for me to give more examples. Every hon. Member, on whichever side of the Chamber he or she sits, has such cases in his or her constituency. That is why, a year ago in the only Government defeat of this Parliament, the House voted to plug that shortfall. It is a shame, not just on Ministers but on the House, that we have let the Government get away with putting off that help until 1993 when many people who are now in that trap will be dead. Their relatives will not forgive the Government for what they have done to community care; nor will those who use the health service forgive them for what they are doing to the NHS.
I read last week that the Prime Minister is to launch a charity appeal for a major London hospital. The health service should not have to depend on charity. Moreover, Ministers will not prove their commitment to the NHS by promoting appeals for charities but will only confirm their lack of commitment to a properly funded system.

Mr. Thurnham: Will the hon. Gentleman give way?

Mr. Cook: No.
I find unexpected common ground with the comments made in the February 1991 edition of the Conservative Medical Society bulletin, which states:
The achievement of a Conservative overall majority at the general election will be a much greater challenge than is often realised".
How true. One of the reasons given is that:
The National Health Service was a key issue in recent general elections and there is no reason to think that this will change.
We do not intend to let that change. We shall put the NHS at the top of the agenda for the next general election and ensure that every elector understands that only if the Government are changed will the damaging changes to the health service be stopped. Only then will we get a Government who will restore the health service to a public service that treats people as equals and is accountable to electors and the local community.

The Secretary of State for Health (Mr. William Waldegrave): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
congratulates the Government on the near 25 per cent. increase in the number of in-patients treated and the near 100 per cent. increase in the number of hospital day cases since 1979 and on the further recent fall in hospital waiting times; welcomes the successful introduction of the Government's reforms which are already leading to better quality services, more responsiveness to people's needs and wishes and improved value for money; notes that the reforms are being backed in 1991–92 by record increases in resources for the National Health Service and in the standard spending assessment for the personal social services; welcomes the Government's commitment to full implementation of its community care policy through local government, by April 1993; supports the Government's objective of using the National Health Service reforms to deliver real improvements in the health of the people through the development of a national health strategy; and looks forward to the forthcoming publication of a consultative document setting out the Government's proposals".
Before I return to the subject of the debate, I hope that the House will forgive me if I deal with a bipartisan issue that has received wide coverage. Sometimes individuals suffer as a result of prejudice and it is necessary for the Government and the House to use their weight on the side of the individual. I refer to the case of Daniel Robinson, the seven-year-old carrier of hepatitis B who lives in Kirklees. With the full authority of the chief medical officer, may I say that there is no reason for other children to be kept from that school. Social contacts of a carrier do not need to be immunised and it is perfectly safe for the children to return to school. I fully support the local consultant in communicable disease control and the Kirklees chief education officer, and I have asked the chief medical officer or his deputy to be prepared to go to Kirklees to help to explain the facts if that would help. The misguided parents who, for no valid reason, are bringing such pressure to bear on a seven-year-old child should desist.
I welcome the opportunity to report to the House the immense achievement of those who manage our national health service and the introduction on time, at the beginning of this month, of the far-reaching reforms of NHS financing and organisation approved by Parliament last year, which they have achieved with no significant

problems. The fact that the hon. Member for Livingston (Mr. Cook) could find only two problems, both of which have been reported in the newspapers and have been dealt with by my hon. Friend the Minister for Health, shows that we can be proud of them.
I am happy to be able to give an account of the start of the period of introduction of the community care programme set out originally in the White Paper, "Caring for People". It will be completed by the beginning of 1993. I shall then sketch the main directions of further policy developments that we intend to pursue and cast an eye over the Opposition's plans to see whether they have anything to offer or any substantial ideas that should detain the House, although I fear that they have not.
We now have in place in the NHS the planned separation between the strategic or purchaser function in the districts and regions and the provider or unit management function in hospitals or elsewhere. Although the plans of the hon. Member for Livingston are disguised by language, they probably accept that division, and that is helpful.
The separation of two quite distinct functions lies at the heart of our reforms and is clearly sensible. One vital job to be done is to analyse local health needs and spend money as effectively as possible to meet them. Another is to manage the clinical and other skills necessary to respond to those needs. The former task, which lies with the districts, involves the setting of public health priorities and strategies and the deployment of money to achieve them. The latter, whether in NHS trust or other hospitals, involves bidding to meet the districts' objectives most effectively with negotiations to achieve maximum benefit for patients sealed in contracts.
For the first time, districts will have a chance to buy health for their people, knowing that when they do so they are spending taxpayers' money to the best effect. As one district manager said:
Now I can concentrate on making choices that can improve the population's health. In the past I became bogged down by administrative issues.
Equally clear is the fact that responsibility for managing the resources of skilled people and capital, which now lies with the hospitals, is already producing a far greater source of involvement in and commitment to the task of giving the patients and their GPs what they want. As one chief executive of a hospital trust put it:
The freedom Trust status offers will allow us to become closer to our patients and to the community and our involvement with GPs will be greater than ever before.
Alongside the district, we now have 300 fund-holding general practices covering 3·6 million patients and spending next year about £400 million, purchasing directly on behalf of their patients from the hospitals. An editorial in Doctor magazine called this
the most important development in primary care in 25 years".
Professor Le Grand of Bristol rightly said:
there are many including some politically unsympathetic to the present Government, who are excited by the idea".
All this is now in place. District contracts are generally completed, and in those cases where final discussions are continuing I am advised that they will be completed shortly. Satisfactory arrangements are in place to ensure that patients' needs are met.
Meanwhile, the benefits that we are seeing for patients in this year's contracts include targets for the maximum wait for admission for in-patient treatment; patients


getting a full week's notice of an elective admission; one in four patients being asked to complete a questionnaire asking for their views of the service provided; a two-month maximum waiting time for an out-patient appointment; all new patients to be seen by a consultant on either the first or second attendance; individual appointment times for out-patient clinics; discharge letters being provided to the patient's GP within 24 hours in 90 per cent. of cases and within three days of discharge in all cases.
The new services for patients offered by different trusts around the country include: patients being notified of appointment dates within 10 days of the receipt of their referral letter; agreement that notification of the outcome of consultations should go to GPs within five working days; patient satisfaction to be measured against a "patients' charter" jointly agreed between the trust and the local community health council; reduction of waiting time to less than four weeks for a routine out-patient appointment; changes already made to catering services in one case in response to a patient satisfaction survey.
As hoped, GP fund-holders are the pioneers of improvement. For example, a Nottingham GP fund-holding practice has agreed with a small local hospital to provide a same-day, walk-in X-ray service. Routine reports will be issued by first-class post the following morning and urgent reports will be faxed to the GP surgery. Under the old system, delays were common and reports were sent second class. The practice is now using that agreement as leverage in negotiations with a large acute unit. Incidentally it also said that it has had more hospital-based health professionals coming in to find out what was wanted since the reforms than at any time in the history of the NHS.
Oxfordshire fund-holders have requested that no patient should wait longer than one hour in out-patients, and that this should be reduced to half an hour by next year. In the North Western district, fund-holders have encouraged the drawing up of clinical protocols that GPs can follow in order to refer directly on to an in-patient list, thus reducing inconvenience to patients and pressure on out-patient departments. In Southend, the patients of one GP fund-holding practice will see consultants specialising in general medicine, surgery, gynaecology, ophthalmology and radiology at their local surgery. As one Manchester fund-holder said:
For the first time we are talking to the hospital side and making them aware of our needs. We see ourselves leading a drive for better services and others will get the benefits too.
Meanwhile, the new GP contract has completed its first year. I hope that we can improve it further and I have had a good discussion with the general medical services committee about that. Let us consider what it has already achieved. The incentives provided by the new target payment scheme for cervical cytology and childhood immunisation have helped to increase the uptake of the preventative services.
More than 80 per cent. of GPs have received payments for reaching targets, thereby assisting in eliminating unnecessary illness. More than 50 per cent. of GPs are being paid for providing child health surveillance services. Nearly 70 per cent. of GPs have been admitted to the minor surgery list. In the first nine months of the new contract, almost 500,000 individual surgical procedures were performed by GPs. More than 450,000 individual health promotion clinics have been held in the first nine months of the contract, covering such subjects as diabetes

and giving up smoking. There has been a massive increase in expenditure on GPs' staff and premises, with more money than ever being invested. Next year's allocation of £564 million is 87 per cent. more than the £302 million spent in 1989–90. The number of nurses working with GPs has increased by 65 per cent. since 1989–90. These are formidable improvements, which we are already seeing in the development of the patient-centred NHS that we believe that the House wants and our people deserve.

Mr. John Battle: At the beginning of the procedure of switching to trusts, I asked the Secretary of State if he would publish the financial basis on which the Leeds trusts were established. He could not find it within his means to produce that information. Why is it that in the past weeks patients have been writing to me saying that they have been told that they must wait longer? Have the improvements not got through to Leeds general infirmary? Will the Secretary of State Commissioner a report to see how the improvements are working out and publish the results?

Mr. Waldegrave: I am delighted that the hon. Gentleman expects to see dramatic improvements in the first week. We shall see improvements—he should wait and see. I shall return to some of the predictions made by the hon. Member for Livingston later.

Mr. Geoffrey Lofthouse: Will the Secretary of State give way?

Mr. Waldegrave: I shall give way three times, as the hon. Member for Livingston did. This is the second one coming up.

Mr. Lofthouse: Is the Secretary of State aware that hospitals which previously showed no enthusiasm for the trusts are being encouraged by the district health authorities to take part? Is he aware that this very day nine senior staff from the Pontefract general infirmary, including five surgeons, have gone off on an eight-day junketing tour to America to study American medicine? That is an attempt to encourage them to opt out when they have not previously shown any previous enthusiasm to do so. Does the Secretary of State support that method?

Mr. Waldegrave: Although the staff may learn some lessons from clinical procedures that they may observe in America, I do not think that they will learn much about the organisation of health care in America—I agree with the hon. Gentleman on that. Whenever an application is brought to me, I have to judge the clinical support for trusts.
The achievement and sheer scale of what has been happening in the NHS may have overshadowed the fact that at the same time we have initiated the introduction of the community care reforms. Local authorities, like district health authorities, will have the duty of assessing the needs of the vulnerable groups involved in a far more rational way and directing the money available to the best and most appropriate care from the private sector, the charitable sector and their own provisions. That policy is now under way.

Mr. Tom Clarke: If that is the Government's intention, why have they infuriated the Association of County Councils and virtually every voluntary organisation involved in the subject by allowing, the week before our Easter recess, a junior Minister in another place to announce the outrageous decision that


the Government intended to ignore the unanimous will of this place and not implement the remaining sections of the Disabled Persons (Services, Consultation and Representation) Act 1986? Do local authorities not consider that legislation crucial to any strategy for community care? Why did the Secretary of State not have the guts to announce that decision in this House?

Mr. Waldegrave: I do not know where the hon. Gentleman was yesterday—perhaps he was engaged elsewhere. My hon. Friend the Minister of State discussed the matter openly in the House yesterday and explained cogently why that issue was not our highest priority at present.
From 1 April, we shall introduce local authority inspection units, new complaints procedures, a new specific grant to provide services for people suffering from mental illness and a new specific grant for services to drug and alcohol misusers. All that effort to improve services in both health and community care has not been at the expense of those who need to use the services as they are now. Proof of that lies in the latest waiting list figures published today.
The figures show that good progress is being made in reducing waiting times. The number of patients waiting more than one year for in-patient and day case treatment fell by 5,100, or 2·5 per cent., in the six months to September 1990. That comes on top of a reduction of 7 per cent. in the 12 months to March 1990. Furthermore, latest provisional figures reported by regional health authorities show that the progress has not only been maintained but has gained momentum, with a 12 per cent. reduction expected in the five months to February 1991. Those significant sustained reductions demonstrate the results of continued efforts to tackle the problems.
Getting the building blocks of the reformed NHS in place has been a great achievement. I am certain that, whatever the vagaries of political fortune in the future, they will never be undone. Now we need to ensure that attention focuses increasingly on the health improvements that we want the new system to deliver. The development of the purchasing role is central to that.

Mr. Charles Kennedy: Will the Secretary of State give way?

Mr. Waldegrave: Perhaps I should take an intervention from one of the lesser parties—I give way to the hon. Gentleman.

Mr. Kennedy: Once the Minister gets past his sarcasm, perhaps he will give a serious answer to a serious question already put by the hon. Member for Livingston (Mr. Cook). Before we come to the further stage of the trusts, will the Secretary of State give a simple explanation to the House about how he will gauge the success of a self-governing hospital trust? What criteria will be used?

Mr. Waldegrave: It would be foolish to say that the success of any hospital—whether a directly managed hospital under the old system or a trust—is measured only by an increase in its activity.
A specialty may well be moved from one hospital to another, or the opening of new functions somewhere else might divert patient flows. We must base a judgment on

patient satisfaction, good use of funds—the normal and common-sense tests by which we would judge the success of any hospital.
The development of the purchasing role is central to the development of the reforms. 1991–92 has seen a steady approach to the implementation of contracting, with relatively few changes in patient flows. That was necessary during such major changes in management and funding arrangements.
I have sympathy with the hon. Member for Livingston and the leader writer in today's edition of The Guardian who complains, as though surprised, that money is not yet properly following the patient. Of course, it is not—the block contracts introduced in the first year limit that process, although it is beginning to happen. I share the enthusiasm—if that is what it was—of the hon. Member for Livingston to see the reforms begin to develop as they will in the years ahead to ensure that money specifically follows the patient with far more flexibility than that offered by block contracts. We are now moving away from the so-called steady state in the introduction of the reforms.
Like the hon. Member for Livingston—if this is what he wants—I want to see further changes in the pattern of services as soon as possible to provide the maximum benefits to patients.

Mr. Robin Cook: If the Secretary of State wishes to convince the House that the new scheme is at least as flexible as the scheme that it replaced, will he answer the question that I put? It is a fair test of the extent to which the scheme meets patient choice. Will he guarantee that every patient on a waiting list at 31 March will receive the treatment for which he or she was waiting at the hospital at which he or she wishes to be treated? Can he give that assurance?

Mr. Waldegrave: The districts may now be responsible for the waiting lists of their residents. If the referor's wish remains the same, it may be granted. However, under the present system the referor could not guarantee that patients would not move from one hospital to another to find either swifter or different treatment. If the referor makes the clinical judgment that a patient should be treated at a particular hospital, that will continue.

Mr. Cook: That was not the question that I asked. I asked what would happen if a patient wished to be treated at a particular hospital. The Secretary of State's answer was that the person would be treated there if the referor decided to refer him to that hospital. Let us suppose that, irrespective of what the health authority says, the patient says, "I have been waiting to go into that hospital for a certain procedure, which I want at that hospital."

Mr. Waldegrave: The patient will have been referred there by his general practitioner. If his GP sticks to his referral and says, "That is the right clinical referral for this patient", the answer to the hon. Gentleman's question is yes. There is no difficulty about that.

Mr. Andrew Mitchell: Is it not extraordinary that the hon. Member for Livingston (Mr. Cook) should raise the waiting list issue since, as we heard earlier, when a Labour Government ran the national health service waiting lists went down by 6 per cent. but under the present Government they have gone up by 48 per cent.?

Mr. Waldegrave: I think that it may be the other way round. Waiting lists went up by 48 per cent. under the last Labour Government. It always enrages the Opposition when we remind them of what happened under their own stewardship of the NHS. It has taken them some years to regather their energy and address the problems facing the NHS.

Mr. Allen McKay: When I asked my local hospital whether it could guarantee that my constituents would be able to benefit from its services as they have in the past, the answer was no.

Mr. Waldegrave: If the referor's clinical judgment is that patients must go to that hospital, that will be the outcome, as I said to the hon. Member for Livingston.
As we move away from the steady state, we need to get benefits for patients from the contracts being placed. We want to get more and better quality health care for the populations represented by the health authorities. They have found this to be an exciting task. They have had to develop and discuss a local vision of what they want the reforms to achieve. They need to develop purchasing strategies, based on a fuller assessment of the health needs of the local community. They need to act together with the family health services authorities to ensure a better balance of prevention and treatment and a better integration of primary and secondary care.
The reforms are bringing about extremely exciting changes which are helping to break down the sometimes arbitrary barriers. As well as the changes being secured through the new contracts for GPs and dentists, there are major opportunities to build on team work between GPs and other health professionals to improve services further. An example of this is the development of minor surgery at GPs' premises. We need to consider whether we have gone far enough in that direction. The NHS management executive's discussion paper, "Integrating Primary and Secondary Health Care", is a clear indication of the direction of these changes and provides a useful framework for local development.
District health authorities must be open in finding out what local people want and discussing priorities. One of the only two cases that the hon. Member for Livingston gave was sterilisation treatment for a particular lady. As I said yesterday, the reforms have disclosed that in that instance the health authority had not for many years conducted sterilisations in its own hospitals. As it now has to specify openly what it does, it was found to be in breach of the guidelines from the centre about what treatment should be available. That matter has now been put right. There was no scandal in that. We want explicit health strategies which set out local priorities. Those priorities will—and, indeed, should—vary across the country, reflecting local health needs.
I have already made clear the important work that district health authorities must take forward in the area of community care. They must work closely both with local authorities and with the family health services authorities. It is right for us at the centre to contribute to that shift in attention to the production of health strategies, both local and national. We shall therefore shortly be issuing a consultative document setting out a suggested approach to the development of a health strategy for England which, if it is to contribute usefully, must go wider than the tasks of the NHS alone.
England has not developed a health strategy in a structured way before, although Wales has. We shall be learning from its experience, and from the experience of other countries. We shall proceed by publishing a consultative document, to be followed in due course —after, I hope, national debate—by a health strategy White Paper.
The House will, I hope, welcome the fact that the reforms now give us a far better chance openly to address the health needs of the nation and to direct resources to meet them. None of the progress that we want will be possible, however, unless the skills of the million or so people in the NHS are properly used.
I have three particular priorities that we shall wish to develop over the next few months. The first relates to the nursing profession. I do not believe that we are yet using the full potential of nursing skills. That is why we intend to establish a new directorate of nursing in the NHS management executive. Nurses themselves, with Government and outside support—notably King's Fund support—have developed some potentially exciting ideas on how to develop their profession. I am currently discussing with their chief nursing officer of my Department what further initiatives we can take to support them and I intend to make a further statement shortly.
My second priority is junior doctors. Steady progress is being made in the implementation of the heads of agreement on junior doctors' hours signed last December. Task forces are being established to propose solutions where local difficulties cannot easily be resolved, and 250 new career grade posts are being funded in England by the Government this year as part of the agreement. We shall play our part, but so must all the interests concerned —consultants, the royal colleges, NHS managers and junior doctors themselves. I do not believe that the juniors will easily forgive failure to make a reality of what is potentially an historic agreement.
My third priority is research and development. In post since January we have the first director of research and development for the NHS. I find it astounding that he should be the first holder of that post 43 years after the foundation of the NHS. None the less, he is now there. Professor Michael Peckham is a man of outstanding ability. As with nursing, his will be a key new directorate in the reorganised management executive. He will shortly publish his research and development strategy for the NHS. One of his vital tasks must be to spread more quickly best and most innovative practice throughout the service. Too often, bureaucratic or professional delay has hindered the spread of new ideas. The agenda is immense. The opportunity for benefit to patients is tremendous.
Labour, I have to say, has contributed virtually nothing to the national debate on health in recent years. First, it bobbed along like a dinghy in the wake of the British Medical Association campaign. How Aneurin Bevan, the patron of the right hon. Member for Blaenau Gwent (Mr. Foot), must have turned in his grave at that laying of the Labour party's sword at the feet of the BMA. Now the BMA, sensibly, is moving on. A recent British Medical Journal editorial said:
As 1 April arrives, simply calling for a return of the old ways and more of the same will not do. The reforms may not address all of the problems of the NHS, but they do improve our capacity to specify the quality of services and to price improvements.


So Labour's dinghy is now high and dry, stranded by the fact that the BMA is moving on.
On every important issue, Labour has cried wolf and been wrong. It campaigned —in effect, on behalf of the drug companies—against the limited drugs list, and it was wrong. It campaigned—in effect, on behalf of the then leadership of the BMA—against the new GP contract, and it was wrong. It campaigned against GP fund-holding and many of the Labour party's own supporters among GPs are telling it that, once again, it is wrong.
When it comes, as it now does, to crying wolf again —for example, about extra-contractual referrals— Labour's credibility is zero. As The Economist wrote recently:
The Labour Party is paying the price for overstating the case against the reforms. Robin Cook, the Shadow Health Minister, insisted that the Tories were preparing to dismantle the NHS. Old ladies worried that hospitals would be either closed down or privatised. But on 1 April worriers will find that the NHS is still firmly in the public sector, financed from taxation, free at the point of delivery. Mr. Cook may prefer silence to eating his words".
Up and down the country Labour Members of Parliament and public relations people tell local people that there will be no difficult decisions under Labour. Its members are against every rationalisation; like the Liberals, they are in favour of every lobby. But in the City of London, when the Leader of the Opposition or the right hon. and learned Member for Monklands, East (Mr. Smith) goes there to lunch, it is a very different story. Then it is, "Not a penny more for health —wait for the economic growth that Labour will produce." In other words, "Wait till the Greek kalends."
We have a right to ask how much more the right hon. and learned Member for Monklands, East would spend. He has made it clear that health is not in the privileged category with a pledge of spending behind it. If he does not intend to spend more, where is the £500 million present for the Confederation of Health Service Employees and the National Union of Public Employees to come from? Out of patient care—that is where it would come from. We have raised the share of health spending in terms of gross domestic product. In money terms we have increased it by half, after taking account of inflation. The right hon. and learned Member for Monklands, East well knows that there is not the slightest chance that Labour could do better.
Luckily, however, the hon. Member for Livingston recently rose to the challenge of clarifying his party's policies on these matters. Pressed by the New Statesman about how much more he would spend, he uttered the resounding pledge:
Our policy and strategy are clear. If you give a figure, you no longer have a policy that consists of a strategy; you have a policy that consists of a figure.
So now we all know where we are. Or, rather, we know where the hon. Member for Livingston is—he is up a gum tree, the only shadow Minister in the history of Oppositions so comprehensively to have lost the argument to his shadow Chancellor even before he got his feet under a real desk. Imagine what the right hon. and learned Member for Monklands, East would do to him if they ever found themselves in power. That is why it is of considerable importance to those of us who care about the health service to see that Labour never again has the

chance to repeat the Healey-Ennals-Foot cuts of 1977–78, the ruthless suppression of nurses' wages which took place between 1974 and 1979, or the destruction of the NHS capital programme which occurred in those years.
The truth is that the health debate in this country is now taking place on our ground. Labour is almost wholly irrelevant to it. Today I can offer the House rather striking proof of this proposition, hot off the presses. In the latest glossy rehash of the Labour party's old policy themes "Labour's Better Way for the Nineties", one finds the following:
Health care markets are out, dreadful things" —
Tory things, and:
Medical markets are in.
I have seldom read more decisive proof of the intellectual defeat of an Opposition party. Labour's irrelevance and intellectual defeat is encapsulated in the motion before the House. I have no hesitation in asking my right hon. and hon. Friends to vote against the motion, and in favour of the amendment in my name and the names of my right hon. Friends.

Mr. Peter Hain: Entering the House after the high profile of a by-election is rather like having been head prefect in primary school, only to be plunged into the obscure anonymity of a secondary school new boy. I am confident that that fate awaits me when I sit down today.
It is an honour and a privilege to represent Neath, or Castell Nedd, whose importance dates from Roman and Norman times, and which has the cosiest town centre in Britain, surrounded by scenic valleys and majestic waterfalls, with, to the west, the a spectacular night-time view of Pontardawe's unusually tall and striking church spire.
There is a strong sense of community, an immense network of voluntary activity, and a rich culture of amateur opera, music, and male voice and ladies' choirs. On the eastern tip of the constituency is Richard Burton's home village of Pontrhydyfen. Amateur sport is widespread—football, athletics and, of course, the best rugby team in country. Recently I was introduced to a class of nine-year-old children at Godrergraig primary school. The teacher said, "Here is a very important person." One of the nine-year-olds got up and asked, "Do you play rugby for Neath?" That, I thought, was a man who had his priorities right.
I have enjoyed renewing my interests in the game at Neath's home ground, the Gnoll. In my youth, that interest involved running on rugby pitches, both as a player and, later, in another capacity, which I shall refrain from describing, as this speech is made with your indulgence, Mr. Deputy Speaker.
I am privileged in another way: I follow two Members, both survived by wives still living in Neath. Margaret Coleman is a highly respected figure in her own right in the community. Jenny Williams, now in her nineties, was a much-loved Labour party activist, and wife of D. J. Williams, who hailed from the close-knit village of Tairgwaith in the north-west of the constituency. In 1925, D. J. Williams wrote of the destructive impact of capitalism in the coal industry in terms that remain true today.
Donald Coleman's tragically premature death was not just a bitter blow to his family; it deprived Neath of a favourite son, and this House of its finest tenor. Although


I will do my best to follow in his footsteps as a diligent constituency MP, I am afraid I cannot hope to match his talent for music and song. The exuberance with which he sang and preached his love for Neath reflects the intense civic pride in the town and in the villages of the Dulais, Swansea, Amman, Neath and Pelenna valleys.
But local residents cannot survive on civic pride, mutual aid and mutual co-operation alone. They take great pride in educational achievement. I have met nobody in Neath who cannot remember how many O-levels he or she has. There is a great tradition of skill and hard work in Neath and its valleys. Much has been done in the face of Government indifference and neglect, but so much more could be done if the publicly sponsored investment in industry, infrastructure and initiative for which the people of Neath and its valleys are crying out were provided.
Surely Neath is entitled to the seedcorn investment, decent training provision and long-term loan finance that only national Government or the Welsh Office is able to provide. The old Blaenant colliery site —headgear still erect as a monument to the last pit in Neath; one of over 30 to close in the constituency in the last 30 years —nestles beneath the village of Crynant in the picturesque Dulais valley. The old Aberpergwm washery and pit site is just below the little village of Cwmgwrach in the Vale of Neath. Both are prime industrial sites, yet both stand idle, black and gaunt, their potential wasting away as 11 people chase every job vacancy, training places are cut to the bone, and businesses go bust. Nobody in Neath wants a free ride. People want simply the opportunity to build a new future.
That future must include high-quality health and community care provision. With its history of mining and heavy industry, the people of Neath suffer disproportionately from ill health. With a higher than average proportion of citizens of pensionable age—22 per cent. compared to 17·7 per cent. for Great Britain —there is a particular need for a properly funded health and community care network. Yet the Welsh Office and the Treasury have still not given the go-ahead for the new hospital that Neath so desperately needs, and West Glamorgan county council has been forced, under pain of poll tax capping, to close one of its old people's homes.
Neath borough council, meanwhile, has had to spend an extra £523,000 on collecting the poll tax, compared with the cost of collecting the rates. On top of this, the borough had to install a new computer system for processsing the poll tax, at a cost of £300,000. Neath's 16,000 pensioners are entitled to question the priorities of a society and a Government that waste such colossal sums of money while hospital waiting lists grow, and responsibility for community care is unceremoniously dumped on local authorities without the necessary resources to finance it.
How can we claim to be caring for citizens in need when the iniquity of the poll tax continues to penalise them so savagely? Even after the recent £140 reduction in the poll tax, residents in the Blaenhonddan area of Neath will be paying £113·66 a head. This is £85 more, incidentally, than I pay as a resident in Resolven, a few miles up the Neath valley, even though we are paying for the same local authority services, because of the discriminatory way the Welsh Office operates the transitional relief scheme.
One resident in the Blaenhonddan area—a woman from Bryncoch—is caring for her 83-year-old mother who has Parkinson's disease. The mother has a tiny widow's pension and has to pay the full £113. Their combined household poll tax bill is £339, yet both she and her

husband are on tiny incomes which are so widespread in the Neath area. The hypocrisy of preaching community care while practising such a pernicious policy is not lost on that woman or her neighbours in Neath. Conservative Members who turn a blind eye to her predicament call to mind Thomas Paine's summer soldier and sunshine patriot who in a crisis shrink from the service of their country.
How can the House claim to be safeguarding the interests of individuals such as a 72-year-old man from the village of Gwaun-cae-Gurwen, where the Welsh language is spoken with pride, whose eyesight deteriorates daily? He has waited 18 months for a cataract operation—a simple, cheap operation. Yet waiting lists for ophthalmic surgery at Singleton hospital have doubled since 1987, and there are now 1,400 local people like him awaiting in-patient treatment. Perhaps most outrageous of all, he was told that he could have the operation next week if he could go private at a cost of £3,000. He might as well have been invited to go to the moon, for that is a sum quite out of the question for someone living on the pittance that pensioners get today. He can be forgiven for noting with anger the grotesque fact that 200 people, just 0·0004 per cent. of the population, now monopolise 9·3 per cent. of the country's economic wealth—some classless society indeed.
Meanwhile, the quality of the environment and the standard of living continue to deteriorate, especially for our elderly. Local bus services in the Neath valleys have been cut ruthlessly. Fares are exorbitant. Yet who can afford a car on a basic retirement income, perhaps topped up by a miner's tiny pension? It is difficult enough for senior citizens to pay their colour television licence and the standing charges on their phone, electricity or gas. It is difficult enough for them to find the money to eat properly as food bills rise remorselessly while the real value of pensions declines compared with wage earners.
If Neath's senior citizens had free bus passes, if standing charges on basic utility services were reduced or abolished for pensioners, if those on low incomes were entitled, like their colleagues in sheltered housing, to television licences for £5 rather than £77, if Neath and Lliw borough councils were not banned by the Government from using their combined housing capital receipts of £7·6 million to build new homes and hit by cuts in housing funding from installing universal central heating and upgrading their existing housing stock, if communities like Cwmllynfell at the heads of the four main valleys in the constituency were not choked by coal dust, disruption and heavy lorry traffic from existing and threatened opencast mines—if all those vital factors were addressed, the standard and quality of life of my constituents would be dramatically improved and, with it, there would be less need to depend upon health and community care provision.
Furthermore, if the curse of "London knows best" were removed, local people would of their own volition radically recast their priorities. That is why decentralisation of power through newly invigorated local councils and an elected assembly for Wales are so vital. That is why a freedom of information Act and an elected second Chamber are so essential. The voice of the people must be heard, not smothered by anachronistic and elitist institutions of Government.
During the last 12 years especially, Britain has become an "I'm all right, Jack" society, putting instant consumption before long-term investment, selfish "mefirstism" before community care, and private greed before


the public good. The result is ugly to behold: the tawdry tinsel of decadence camouflaging a society rotten at the roots.
I thank the House for its indulgence or, as we say in Neath, "Diolch Yn Fawr."

Mr. Dudley Fishburn: I congratulate the hon. Member for Neath (Mr. Hain) on his maiden speech; a most excellent maiden speech it was. I have no doubt that, in the years ahead, the hon. Gentleman will make a substantial name for himself in the House, as he already has done outside. Being a by-election victor myself—we are rather fewer on these Benches than on the Opposition side—I have something in common with the hon. Gentleman. Not least, I congratulate him on being so quick off the mark in making his maiden speech, on the day after his introduction to the House.
The hon. Gentleman will learn, as I am afraid we have all learnt, that, in debates on the national health service, things are inclined to move at a rather predictable pace. New ideas from the Government on the restructuring of the national health service have all had the same hallmarks. They have all been radical and effective, and they have all been bitterly opposed by the Labour party.
The result is that, under the shadow Secretary of State, the hon. Member for Livingston (Mr. Cook), the Labour party, which for so many years contributed to the debate on health care not just in Britain but throughout western Europe, has boxed itself into a corner where the only contribution that it can make to the debate on the NHS is no, no, no. That has been a great disservice not just to the Labour party itself but to the general debate in Britain, in western Europe and in the United States about the way in which western democracies can seek to deliver better health care where it is needed: patient care as far away from the Government and as close to the individual as possible.
When my right hon. Friend the Secretary of State announces a new strategy for health in Britain, I fear that the debate which we shall have on the new ideas will be concentrated largely on this side of the House. I should like immediately to put two ideas into that debate and to welcome what my right hon. Friend said about setting up a new directorate for nurses. The nursing profession, which was one of the first to benefit from a radical shake-up under the Government when nurses were put on a professional career basis, is still one of the most under-utilised sections of the national health service. I congratulate my right hon. Friend on announcing at the start of his strategy that there will be a new directorate for nurses.
I hope that, in a national health service centred on patient care, one of the first things that that directorate will do will be to examine the possibility of extending to nurses the right to prescribe a limited number of specified drugs and medical products. When that happens, I hope that we will not hear, no, no, no from the Labour party, as we have heard on every other new idea.
The notion that Britain's nurses—initially the 29,000 district community nurses—should be able to prescribe certain products has been gathering intellectual respectability and popularity over the last few years. Initially it

was dealt with in the Cumberlege report which recommended that nurses should be able to prescribe a limited number of products. The Select Committee on Social Services considered the matter and said the same thing. The Department of Health had its own study: in Britain, we often seem to prefer studies to action. That study, the Crown report, recommended that permitting nurses to prescribe would be a liberal, effective and humane extension of our medical services.
I gave that initiative a further kick on its way when I introduced a ten-minute Bill on the subject some time ago. I hope that the Department of Health will incorporate in its new strategy proposals to permit Britain's 29,000 district nurses to write prescriptions. That is already permitted in the United States and Canada, and it would have an immediate impact here on alleviating suffering and on bringing medical services to patients in their own homes under community care.
It is the community nurse who looks after people who are home-bound, not the doctor sitting in the surgery. The nurse knows when the patient needs to have a new product prescribed and what it should be. It is wrong that patients should have to go to surgeries to pick up prescriptions written by overworked doctors. It would be far better for prescriptions for a number of standard products to be written by nurses.
I hope that that proposal is incorporated in the strategy for health care that we develop in the next few years. The better delivery of health care, rather than a changed framework in which that care is delivered, represents the right way forward as we digest the radical reforms of the past four years. I hope that the Labour party will contribute its ideas for improving health care, as that is the way in which to provide a richer and better health service.
In the past 30 years. western society has understood that many women prefer to go to women doctors. However, we have not grasped the fact that many people from the ethnic minorities prefer to be treated by doctors who belong to their own ethnic minority. It is a great shame that so few of those belonging to the ethnic minorities, particularly those of West Indian and black origin, do not graduate from our medical schools. I represent the constituency with perhaps the largest ethnic minority of those who had the good sense to return a Conservative Member of Parliament. The problem of recruitment does not rest with the medical schools alone. The Department of Health must reach our sixth forms to encourage those from the ethnic minorities to go to medical school in the first place.
In my constituency, there are 200 practising GPs, but there is not one doctor of West Indian origin. In the next 20 years, as we attempt to have a patient-centred health service, we must try to deliver the type of services that patients want. We should consider the recruitment of ethnic minorities to train as doctors as part of that policy. The Department of Health should take a lead in that.
In the future, many ideas will be proposed for improving the health service. The Conservatives have had many ideas—all the positive ideas—on how to develop our health service. The more people who submit their ideas on the next stage the better. In the years ahead, I hope that the hon. Member for Livingston will cease to say no and will allow his colleagues to submit positive ideas to improve our health service.

Mr. Charles Kennedy: I do not intend to continue the arguments advanced by the hon. Member for Kensington (Mr. Fishburn), but it is important to consider what happened when we considered the National Health Service and Community Care Bill. In Committee many probing, constructive and critical amendments were moved. On some occasions such positive contribution came from Conservative Back Benchers, including the hon. Member for Harlow (Mr. Hayes). The Opposition made a positive contribution on every occasion, but the same cannot be said of the Minister. On every occasion she simply said no, no, no, or promised that it would be all right on the night. Whatever Opposition or Conservative Members sought to do, the hon. Lady assured them that that was already intended by the Government and that their commitment was good. The hon. Member for Kensington was a bit wide of the mark to suggest that there has been no constructive debate on the health service in the past. The difficulty has been trying to get a constructive response from the Government to any ideas advanced.
The Government have been in office for 12 years. Today, however, the Secretary of State outlined how much better all the changes will make the system and he described the improvements that will flow from them. One must ask what the Government have presided over in the past decade and more that led to such enormous problems that required such a drastic set of remedies.
Finance underpins the debate on the health service. The new revised trusts, operations and GP contracts mean that the planned expenditure for 1991–92 is £32 billion —a massive sum of money. That planned expenditure assumes a general inflation increase of 6 per cent., but that forecast is likely to be too low. If we spent proportionately as much on health as other western countries, the total level of expenditure would be closer to a ceiling of £38 billion.
The Secretary of State mentioned the proportion of our GDP that is devoted to health. He said that he was pleased to note that that contribution was rising. In this country it has risen to 6·1 per cent., but the average for the OECD member states is 7·5 per cent. By international comparison we still continue to lag behind.

Mr. Stephen Day: Our figures do not bear comparison with international ones because they are largely misinterpreted. If one considers the levels of public expenditure on health in various countries, Britian is well up the list. The fact that other countries do better than us is due to the fact that they spend a larger amount on private health.

Mr. Kennedy: It is always the same with the Government: whatever the policy, when the figures are not as rosy as they would have us believe, it is all put down to misinterpretation. Doubtless all of us who shouted about the unemployment level in the 1980s misinterpreted the figures. We have had goodness knows how many changes to the unemployment statistics and each has led to a diminution in the level of unemployment.
We are now told that the method for calculating the rate of inflation is unacceptable and there are moves to take the mortgage interest relief out of the calculation. One wag suggested that if we wanted to improve our balance of payments it would be much fairer and more sensible not to include imports in the equation. In that way the economy

would look a great deal healthier. I am somewhat sceptical when I hear Tory Back Benchers complaining about the reliability or otherwise of figures.
The resources devoted to the health service in the present financial year and the real-terms contribution to it will be eroded once again. That will happen because the health service must bear the brunt of pay review body awards that are staged and phased in such a way that they fall heavily on local health service provision. That has a great impact on all NHS funding.
I agree with the hon. Member for Livingston (Mr. Cook) about the costs of administration. We are witnessing a great disgrace in domestic policy, which has not been brought about by external events or economic circumstances—the poll tax. That policy was not inherited from another Administration, but it was conceived, delivered and botched by the present Government. The wastage of domestic expenditure on the administration of the poll tax will not be matched by the total administrative overheads of the health reforms, but, according to a recent survey conducted by the British Medical Association, those reforms are likely to add an extra £80 million on administrator salaries this year alone. That is almost six times the £14 million that the Government promised in December to cut junior doctors' hours of work. It is more than twice the £35 million that the Secretary of State for Health put towards cutting waiting lists in January. That is the reality of what this nonsense is costing us as regards the other deployment of resources that could and should be taking place.
The Secretary of State was not anxious to come clean about patients' rights under the new set-up. It is worth recalling the former Prime Minister's words. I know that that is no longer in vogue on the Conservative Benches. The wall posters along Whitehall are being taken down now that the change in leadership has taken place. In the introduction to the White Paper "Working for Patients" the right hon. Lady said:
We aim to extend patient choice.
Patients sometimes have strong feelings about where they want to go. They may have lost a relative or friend in a particular hospital and may find a hospital difficult to reach by public transport. A GP may think that the best specialist for a patient's condition is at a hospital some distance away.
What has been happening? General practitioners have accused the Government of lying to the public and have predicted that the issue could become as controversial as the poll tax because it became clear in the past fortnight that, apart from in exceptional circumstances, patients will be allowed to go only to hospitals with which their district health authorities have made contracts. What we are hearing about the extension of patient choice is not the case.
The Observer of 23 March quoted Dr. John Watson, chairman of Surrey's local medical committee, a GP representative committee. He was told that he can no longer refer 1,500 of his patients to his local hospital for physiotherapy and he is advising them to write to their local Member of Parliament. He said:
The changes have removed my freedom of referral. The Government has misled the public over this for the last two years. The NHS will be the downfall of the Government. I have voted Conservative for the last 30 years, but I will not do so next time.
That is a GP in the south of England, in true blue Conservative country, talking about his right as a general


practitioner to refer patients to the hospital of his choice. It stands in stark contrast to the rubbish that we got from the Secretary of State today.

Mr. Barry Field: I am obliged to the hon. Member for giving way and I am pleased to see that he has recovered from his illness. I trust that he will be able to confirm to the House that his excellent recovery is a result of the excellent health service that we have in this country. Could he confirm to me that he would deprecate doctors who lie to the electorate and especially those who took part in drawing up plans for the closure of hospitals when a new health service hospital was to open and who now endeavour to distance themselves from those plans because they see a few votes in it during the forthcoming elections?

Mr. Kennedy: Like every hon. Member in the House, I am never in favour of misleading, far less lying, to the electorate. It may be a local Isle of Wight problem.

Mr. Field: Very much so. I can confirm that.

Mr. Kennedy: I think that it would be helpful, especially for the Liberal Democrats, if the hon. Member for the Isle of Wight (Mr. Field), whose constituency we hope to regain at the next election, put it on record that one of his local GPs is a liar. If he would care to do so I shall happily give way.

Mr. Field: It was a member of the district health authority, appointed by the county council. He never once voted against the plans to shut local hospitals, but he has now put out a leaflet saying that he condemns those plans. He is extremely well known on the Isle of Wight, so there is no need to name him.

Mr. Kennedy: I think that we have achieved something tonight—another gain at the next election and I am grateful to the hon. Gentleman. However, we are not casting doubt on Dr Watson from Surrey, to whom I referred. That gentleman's comments speak for themselves. When we hear so much verbiage from the Dispatch Box it is worth letting the people in the health service speak for themselves. We do not often hear Government Ministers quote them.
The British Medical Association's central consultants and specialists committee recently conducted a survey of attitudes towards the changes and how people anticipated that they would work out. I shall give three quotes. The first is from the BMA's local branch in Wales, which said:
Measures include—no new orders and reduction of stocks to the barest minimum.
South East Thames RHA said:
Completely disastrous—we have ½ million overspend on 1.4.1991 (i.e. we failed to make the level playing field). We must do 5 per cent. less work next year.
So much for progress. North West Thames RHA said:
Despite a savage bed closure policy, which has increased our waiting list by approximately 150 per cent., there were no financial savings recorded overall in the latest monthly figures available to us. There seems little or no prospect of any improvement after 1 April. Indeed; a worsening of the present situation, with further cuts, particularly in surgical bed numbers, seems likely.
That is the reality of what is happening, not the nonsense that has been spilled out by the Secretary of State for Health.

Dame Jill Knight: Could the hon. Gentleman also confirm the reality of the fact that not one reform suggested by any Government, of any political persuasion from either side, has been accepted without a fight by the BMA? There has never been a reform that it has not objected to.

Mr. Kennedy: The BMA has a representative capacity on behalf of its profession to engage in on-going discussions with the Government and to put forward the interests of its members but also in the interests of what it views as decent standards of medical care. One cannot dismiss the BMA, which represents doctors up and down the land, by saying that it always takes a vested interest and does not also pay some attention to medical care overall.
I can think of a number of reforms that the BMA would not oppose—for example, lifting the charges that have been imposed for dental and optical treatment. Doctors throughout the country want that and regularly say so in our constituencies. People on low incomes have to bear the burden of prescription charges and doctors would be happy for that to change as well.

Mr. Robin Cook: What about maximum patient lists?

Mr. Kennedy: As the hon. Gentleman rightly says, there is also the question of lists. There has been constructive argument by Opposition Members in the House and in Committee about that. The BMA would be happy to see some of those changes. However, we never hear about that from Government Ministers.
The other half of this motion rightly dwells on community care and I was fascinated by the words that the Secretary of State chose to use. "Sir Humphrey" was working overtime on this one. As we know, the Government have postponed community care—of that there is no doubt. The previous Secretary of State announced it.
I wrote the Secretary of State's words down with care. He did not use the word "postponed" when talking of community care, although everyone knows that that has taken place. He said that he had "initiated the introduction" of community care. In other words the introduction is not quite with us yet, but the motive force is taking place. I prefer the word "postponement" and I also favour using one word rather than three where possible.
Given the present poll tax shambles, what will be the funding basis for local government and for the delivery of community care, which is already suffering this postponement? Now there is uncertainty about the future structure, never mind the funding, of local government. How can there be any certainty or confidence in the caring and professional services that will have to make a reality of community care against such a backdrop of uncertainty? The Government have not made the case for these reforms and the authentic voice of people in the health service, who are grappling with the problem daily, is further clinching evidence that these reforms are unnecessary, that they do not inspire public confidence and, more importantly, are not the answer to a complex problem which is rooted in the fundamental lack of political will on the Conservative side of the House, as has been proven in the past 12 years.
We shall certainly vote for the Labour motion and against the record of this Administration and their ideas for the future.

Mr. Deputy Speaker (Sir Paul Dean): I remind the House that the 10-minute limit on speeches is now in operation. Hon. Members might find it helpful to keep an eye on the digital clocks.

Mr. Stephen Day: I join in the congratulations to the hon. Member for Neath (Mr. Hain) and in his tribute to his predecessor.
The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) did not address himself to my intervention. The fact is that Britain has a marvellous record, unequalled in Europe, on public expenditure on health. It is right that that should be the case. However, other countries in Europe have a greater commitment to the concept of private health care. That is not an argument for or against private health care; it is a matter of fact. I am sorry that the hon. Gentleman did not acknowledge that.
I served on the Standing Committee that considered the National Health Service and Community Care Bill, which was a most enjoyable and interesting Committee. I was struck by the attitude of many Opposition Members towards the health service and its prospects. Almost to a man—or a woman—they never failed to cite cases of undoubted distress, which one readily accepts exist and which arouse sympathy in any human being. But they never mentioned the fact that the number of in-patients and out-patients treated has increased dramatically since the Government have been in power. There will always be individual cases which will give rise to concern and one regrets that. Indeed, the founding fathers of the NHS warned Parliament and the country that the health service would never meet demand, because demographic pressures would increase, and that we must never expect more of it than it can deliver. Those are precisely the problems that we face.
If Opposition Members accept such inherent problems and those created by technological advance, it is strange that they criticise the existing system yet resist reform. Surely reform is the only way to ensure that we have a health service in the year 2000.
The Opposition frequently do a great disservice to the NHS. They appear never to recognise, in public at least, the demographic pressures that it faces. They do not seem to appreciate or to accept publicly that our population is aging. We all hope that we will become part of that problem. The number of people as a percentage of the population who provide money for the health service through taxation is becoming smaller. That is a fact which no party of whatever political persuasion can run away from. Yet that point is never recognised by Opposition Members.
A party that simply stands back and objects to reforms that are designed to drag that service into the 1990s is the enemy of that service, not its friend. The enemies of the service say, "Stand still. Leave it as it is. Don't reform anything because it will destroy the service." The one way to destroy the service is not to reform it. How can a system that was designed to meet the needs of the 1950s meet the needs of the 1990s? We cannot run away from that reality, yet the Opposition constantly seek to do so.
I find it sickening to hear Opposition Members accuse Conservative Members of not caring about the NHS, as though they have a monopoly on caring. That is offensive. There may be differences between us about how the NHS should be run and operated, but our commitment to its existence and its future is equal to that of the Opposition. That commitment can be proved by the massive expenditure that the Government have put into the NHS —far more than any Labour Government have ever achieved and far more than any Labour Government would ever achieve.
As usual, Opposition Members say that the only way to solve the problems of the NHS is to throw more money at them. If the problems of the NHS could be solved by throwing more money at them, we would have solved them 10 times over. It is not as simple as that and the British people recognise that. They also recognise that the Opposition cannot claim, as the hon. Member for Livingston (Mr. Cook) did today, that the NHS is at the top of their list of priorities. If it is at the top of their list of priorities, it is alongside education, training and transport. The public perceive that their promises in that regard are shallow.
If the public want to protect the NHS and ensure that it is there for the future, the Government's reforms will gain their backing. During the time that I served on the Committee considering the National Health Service and Community Care Bill I, like many hon. Members, was inundated with letters from patients who were frightened by the British Medical Association's campaign, but I cannot remember the last time that I received a letter complaining about the reforms. Indeed, one practice in my constituency is complaining that it cannot introduce the changes fast enough. My hon. Friend the Minister for Health was kind enough to meet the doctor representing that practice and I am grateful for that.
The climate has changed. The Opposition may try to turn the Government's reforms into a demon, but they are the one way in which to save the NHS for the year 2000.

Mr. Keith Bradley: I start by paying a tribute on behalf of the Labour party to my hon. Friend the Member for Neath (Mr. Hain). He delivered his maiden speech with eloquence and passion and it is clear that he will not remain anonymous on the Back Benches with some of us for much longer if that is the calibre of his contribution in the House. I congratulate him.
The Opposition motion today could have been written for the people of Manchester and in particular for my district health authority of south Manchester and my constituency. If we look at the chapter of disaster of health care there we see that Christie hospital has opted out and there is a proposal to close the maternity unit at Withington hospital and eventually to close the whole of that hospital, although the health authority has denied that, saying that it is merely relocating it. That is a novel way of allowing patients to continue to receive their health care at the same hospital. Also the plan for the Central Manchester health authority to opt out has gone through.
The Secretary of State alluded today to the wealth of GP practices in Manchester which have taken up the challenge of becoming fund-holders, but to my certain knowledge only one has gone down that road. The way Ministers have scuttled in and out of south Manchester in


the past few weeks trying to boost the opt-out rate and the number of fund-holding practices shows their lack of confidence. The way in which the people of Manchester have responded to those reforms shows that they have no relevance to the future of health care in that part of Britain.
I do not want to spend the short time that I have discussing the sour taste left in the mouths of local people as a result of the opt-out of Christie hospital. My hon. Friend the Member for Livingston (Mr. Cook), in his devastating critique of Government policy earlier, referred to Christie hospital and the way in which Mrs. Kenrick did not receive treatment; the way in which, when the trust was launched, instead of looking at patient care senior management had a champagne and salmon party; and the queue-jumping proposals for people in urgent need of cancer care. Those decisions speak for themselves, and they are not lost on the people of Manchester.
As for the waiting list statistics, the Government continue to fiddle with them to make them look good. Manchester Members of Parliament recently received a letter from the chairman of the trust in central Manchester which stated that at the end of March 1991 the number of patients waiting for more than a year had reduced by 541, or 20 per cent., hailing that reduction and pointing to success in general surgery. At the same time as I received the letter, I received from a local GP on behalf of a patient a letter from the trust hospital in central Manchester stating:
I do appreciate your concern for your patient and I am afraid that my good intentions to admit him in February this year for surgical correction … have been thwarted by our lack of beds. Approximately 25 per cent. of our surgical beds have been closed and this you will understand makes planned admissions extremely difficult in view of our continuing commitment to emergency services. I am afraid that until these beds are restored, treatment for patients like yours will continue to be much of a lottery. I will do my best to expedite his admission.
At the same time as the trust hails the reduction in waiting lists it fiddles statistics because it is closing beds and denying referrals to the hospital.
The closure of the maternity unit and the single site hospital planned by South Manchester health authority is causing a massive public outcry. The closures have been caused by a continuing financial crisis in south Manchester which has arisen because the Government have continually underfunded pay awards and have not allowed for the true rate of inflation in the health service. They have forced the service to make efficiency savings of 1 per cent. each year, but we know that that is really a cut in service funding. They have not fully funded clinical regrading, and over the years managers have tried to manage their way out of the financial crisis by closing wards. They closed wards for the elderly on the back of the intention to introduce community care. They thought that they could get away with closing long-term beds for the elderly because people would be moved into the community. Community care has been abandoned for two years, but the beds have not been reopened because the money is not available due to the financial crisis. Many people are left in their homes without support services and without the proper supervision and health care that they need.
Recruitment has been frozen and there are longer waiting lists. That could not go on, so rationalising the service was considered. In particular, the closure of the accident and emergency department in Wythenshawe hospital and the maternity department in Withington hospital was considered. The public outcry about closing the accident and emergency department in Wythenshawe hospital, which is next to Manchester airport, was so great that the authority backed off. It has now said that there should be accident and emergency departments at both centres. That seems crazy because it now says that it will close Withington hospital.
The authority has not backed away from the proposal to close the maternity department. I am pleased to see that the Under-Secretary of State for Health is present for the debate. He has agreed to meet me before making the final decision. The community health council has objected to the plan and the Minister is aware of that. The CHC's 10-page document clearly set out counter-proposals. I hope that the Minister has that document. When the matter went to the regional health authority, the cogent and clear arguments contained in those 10 pages were reduced to four and a half lines. Members of the regional health authority did not have a full document and made their decision on that short summary.
I hope that when the Minister reviews the decision he will look at the full document and recognise the importance of maternity care in Withington. The matter is made even more important by a recent health care report by South Manchester health authority which points to the high level of infant mortality in the district. It is higher than in most parts of the country and higher than the national average. If we are to address the problem of infant mortality we need local maternity services and local ante-natal and post-natal care. That is what the people of south Manchester want.
The single site proposal was delayed until the implementation of the National Health Service and Community Care Act 1990. There were two reasons for that. The Government wanted stooges on the health authority in South Manchester to rubber stamp the authority's proposals to close the hospital. Not one of the new members of South Manchester health authority lives in that area or uses the hospital on which the authority is making a decision. The closure was the first item on the agenda of the new health authority. There was not a word of debate about the decision which went through on the nod and not one member of the new authority asked a question about the proposal. The matter was dealt with by people who have no interest in the area and who do not receive health care from the hospitals that they are closing.
One of the clear reasons for the health authority's proposal to close the hospital is the run-down in the fabric of the buildings in Withington hospital. In a financial crisis the easiest thing to go is the maintenance budget. In the 10 years from 1982–83 until now the amount spent in real terms on maintenance has been more than halved. No wonder the buildings are falling apart. That is bound to happen when the Government do not put in the resources to ensure that local hospital buildings are properly maintained.
The people of Manchester have clearly said that they want to keep their hospitals local and want access to decent health care in the communities in which they live. The "Save Withington Hospital" campaign has been magnificent and I pay tribute to those who have been


involved in it, especially the campaign's chairman Tom Grimshaw and its secretary Brenda Stevenson. They have galvanised people into trying to save the local hospital. The campaign has all-party support and even local Tories are campaigning against their own Government because they recognise that the hospital must be saved.
A week last Saturday 3,000 people turned up to link hands around the hospital to say that the Government must not touch it. More than 70,000 people have signed a petition. The Government's national health changes do not address the issues of decent hospital care in Manchester. We urge the Government to intervene now and tell the regional health authority, which meets on Tuesday, that it must throw out the plan and look to decent health care in our communities. That would ensure that Manchester people received the hospital service of which they had previously been proud.

Mr. Jerry Hayes: I congratulate the hon. Member for Livingston (Mr. Cook), who is not in his place, on his courageous speech. It was courageous because the hon. Gentleman made it absolutely clear that spending on the health service will be at the top of Labour's agenda at the next general election. I do not know whether he has spoken to his hon. Friend the shadow Chief Secretary, but I do not think that she will be pleased by his proposals.
The hon. Member for Oldham, West (Mr. Meacher), who is the shadow Social Security Minister, will not be pleased because we were told some weeks ago in a similar debate that pensions would be Labour's top priority. On 9 December 1990 the shadow Leader of the House told us that education would be Labour's top priority. The electorate and the House would like to know whether there will be so many priorities that they will be meaningless or whether the Opposition are making promises that they cannot possibly deliver.
On 20 April last year, which was my birthday, the hon. Member for Livingston pledged that a Labour Government would spend £3 billion on the national health service. What has changed, apart from the fact that in the past two years the Government have spent £6 billion on the NHS? It is therefore hardly surprising that socialist economists such as Professor Julian Le Grand, the founder of the Socialist Philosophy Group, said that the Conservative Government had promised an extra £3 billion for the next financial year. He says that it is difficult to imagine that Labour could do much better, given the other demands that Labour will undoubtedly face on taking office.
Yesterday Opposition Members heard me quoting from the Labour campaign document on health spending. They said that the problems would not be solved and that finance could not be provided overnight. I give the Opposition credit for the fact that they have made it perfectly clear in that document and in the debate today that they will spend far more than this Government on the health service. However, they will not be spending it on patient care, on the poor devils in hospital. They will be spending it on bureaucracy, because that is Labour policy.
The Labour party will give us an army of quangos, a technology inspectorate, a health quality Commissioner and a food standards agency. It is talking about regional councils to discuss the various quality controls within

regional health authorities. Under the Labour party's proposals, quality will be built into contracts. I simply ask hon. Members to visit such places as Bromley, which is putting the contracts into place; they are very impressive.
The Labour party talks about value for money and quality—so why does it want to abolish the Audit Commissioner? What has that Commissioner done for health authorities during the past six months? It has given each health authority a financial profile, something almost unheard of in the history of the NHS. It has provided a number of discussion documents that show where savings can be made to improve patient care. Through the changes and procedures suggested by the Audit Commissioner, about 300,000 additional operations could be provided without any additional cost. There could be savings of £30 million just by sorting out the heating problems and another £30 million through running an efficient telephone service. There is plenty of scope for bodies such as the Audit Commissioner, which is interested in value for money and in money being spent on patient care.
I want to go into some depth on what the Labour party is promising. We have the document, which says:
Labour will require health authorities and health boards to give new priority to disease prevention and health promotion.
Hooray. It continues:
This health strategy will set targets to be achieved over a five-year period"—
hooray—
such as a reduction in smoking, increased participation in exercise, and a narrowing of social inequalities of access to health care.
I agree with every word, but I do so because it happens to be Conservative party policy.
What heading has the Labour party given to that policy? It is "Promoting better health". Does not that ring a bell? Was not there a White Paper called "Promoting better health", which said all those things years ago? What was my hon. Friend the Member for Derbyshire, South (Mrs. Currie) saying when she was a junior Minister at the Department of Health? It was all that the Labour party is now saying in presenting its brand-new health promotion policy.
The Labour document says that the Labour party will do even better than that. It states:
The greater emphasis in our health strategy on health promotion will require new priority for primary care.
That sounds new. It continues:
Labour will therefore renegotiate the GPs' contract to reduce the pressure which it puts on them to seek larger patient lists.
I may be wrong, but I thought that patient lists had been going down consistently over the past few years. That is certainly what general practitioners say. I am pleased to say that most of them are happy with the new contract. My right hon. Friend the Secretary of State has said that he will sit down and talk to them about any areas of difficulty. There is dialogue between the British Medical Association and the Department of Health, and the Opposition should pay attention to that. The real gripe of general practitioners during the first negotiations was the very matters that the Labour party wants to promote. General practitioners complained that they had to take on health promotion tasks, the screening of 75-year-olds, and the provision of inoculations. It is precisely the sort of contradiction that I would expect from the Opposition.
The document says:


Labour will scrap the indicative drugs scheme which puts a cash budget on the drugs a GP can prescribe.
Just a moment, did not the BMA and the Opposition shadow spokesman on health only late last year publicly admit that there was no cash constraint on the amount of prescribing? Have not the Audit Commissioner and a number of other independent bodies made it quite clear that we have saved more than £200 million in drug prescribing, which has gone directly to benefit patient care? Should not that be welcomed? It is certainly welcomed by general practitioners and by the BMA. However, the Labour party wants to scrap it. What will it put in its place? The document says:
In its place we will encourage greater efficiency in prescribing by requiring"—
that is the key word—
greater use of generic prescription.
If this Government introduced legislation requiring general practitioners to prescribe in a certain way, all hell would be let loose from the Opposition and the BMA.
The document also says that the Labour party
will invest in the modernisation of our hospitals and tackle the backlog in maintenance and repairs—although we cannot expect to be able to put right overnight the neglect of years.
That is another fudge on the finances.
We have been talking about the trade unions, and it was interesting that yesterday the Labour party said that one of its great policy planks was that there would be beer and sandwiches at No. 10. There is nothing wrong with discussion and negotiation, but there is a price for that, and that price would be a statutory minimum wage. How much would that cost the NHS? We all know—it is a matter of public record—that it will cost £500 million. Where will that money come from?

Mr. Eric Martlew: Will the hon. Gentleman give way?

Mr. Hayes: I am sorry, but I have only a minute left. The document says that Labour recognises that the pay and conditions of certain health staff
have worsened markedly under the Conservatives.
My hon. Friends have refuted that claim. The document continues:
We will halt this deterioration—and develop fairer and more rational ways of settling pay and conditions for those health service employees.
It will be done in smoke-filled rooms by the paymasters of the Labour party.
It is interesting to note that the document states:
In order to end the efficiency trap, budget allocations to hospitals will be flexible. Total spending must remain within cash limits but the increased funding to which we are committed will be used to create a reserve at Regional or District level which can be released in the course of the financial year to those hospitals who have outperformed their agreed targets.
What financial control will be there? What financial management will be there? There will be absolutely none. That is why I say to the House that the Government have nothing to be ashamed of in their health policy, and that is why I support the Government amendment.

Mr. Tom Clarke: I am delighted to join in the congratulations to my hon. Friend the Member for Neath (Mr. Hain), who made an excellent maiden

speech. His constituents have every reason to be proud of him, as are we all in the Labour party. We look forward to many further speeches from him over the years.
In a remarkable response to an intervention of mine, the Secretary of State asked where I was yesterday during health questions. I was at a meeting with one of his colleagues at the Ministry of Defence—a meeting that I had been trying to obtain since the beginning of winter —about an important matter in Twechar in my constituency. I should not have thought that the few brief moments that were given to community care as a result of the accident of one question being at the top of the list represented a considered debate on the Government's remarkable decision to ditch without ceremony sections 1, 2, 3 and 7 of the Disabled Persons (Services, Consultation and Representation) Act 1986.
The importance of community care and of that Act is all the more necessary because of what has been happening to the health service. Listening to the exchanges during this debate, one would think that it is not just a question of having a two-tier health service, although it certainly is. There are actually two health services—one is in the imaginations of Conservative Members and the other is the reality with which hon. Members deal day after day.
We know the problems. We know that my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) presented a petition organised by Health Alert to save the West Middlesex hospital. Lest it be thought that I am concentrating on important English matters, I should add that people in my constituency would not recognise the health service that the Secretary of State described this afternoon.

Mr. John Marshall: Will the hon. Gentleman give way?

Mr. Clarke: I will not give way as time is short.
My constituents are fully aware of the case of the 71-year-old woman who was refused admission to two hospitals and subsequently died. They are aware of possible closures not just of wards but of hospitals in and serving my constituency—for instance, Stobhill, where ear, nose and throat, neurology and maternity units may be closed. Patients in my constituency—and those who visit them—will then face much longer journeys to hospitals further away than necessary to find proper health provision.
My constituents are worried about debate over the future of Gartloch hospital. The Greater Glasgow health board appears to be taking decisions about psychiatric hospitals and psychiatric provision without bearing in mind the importance of community care. My constituents are also worried about the future of Stonyetts and Birdston, and they are not alone in their concern. They know that it is not enough for society to concentrate on the demands of the health service, important though they are, at the expense of the 90 per cent. of our people in the community whose rights and needs must also be respected.
This is why I am appalled—I cannot disguise my anger —at the way in which the Government have responded to the Disabled Persons (Services, Consultation and Representation) Act 1986. We were told by one Minister after another—including the former Prime Minister, the right hon. Member for Finchley (Mrs. Thatcher), and the present Prime Minister—that the Government's aim was to accept the will of both Houses and to implement that


Act when resources became available. As a Minister with responsibility for the disabled, the present Prime Minister, speaking of the implementation of the Act in stages, said:
This should help to make progress towards establishing such a timetable."—[Official Report, March 1987; Vol. 112, c. 157.]
Until the announcement was sneaked in on the Friday before the Easter recess by a junior Minister in another place, we all accepted that that was the Government's intention. As Chief Secretary to the Treasury, the Prime Minister also said:
The Act of 1986 was originally passed upon the premise that it would be brought into action over a period."—[Official Report, 29 October 1987; Vol. 121, c. 441.]
This spectacular U-turn has yet to be explained by any Minister. The Minister for Health seeks to argue, and has argued elsewhere, that after the enormous amount of consultation which took place before the 1986 Act was introduced—far more consultation than the one week between the Government's White Paper on community care and the Bill that followed it—it is not necessary to implement all its sections. The consultation preceding the 1986 Act meant that sections 1, 2 and 3 provided the right of advocacy and assessment; and section 7 meant that people leaving long-stay psychiatric hospitals would be entitled to assessment and were assured that the House would attempt to reduce the number of people released from such hospitals into non-existent community care—often into cardboard cities. The approach to community care embodied in the 1986 Act, to which the House gave a great deal of credence, has been abandoned, and we cannot and will not be convinced that the community care sections of the Government's National Health Service and Community Care Act transcend what we tried to achieve in 1986—they do not and they cannot.
During the passage of the National Health Service and Community Care Act and the Children Act 1989—the latter also featured in the junior Minister's reply in another place—it was never said that the Government were planning to drop these vital sections because they were covered by those two subsequent Acts. The Government intend not just to postpone but to abandon community care until 1993. We cannot pretend that the 1986 Act was never passed.
We are told that the Government believe in citizens' rights and voluntarism and that they are prepared to listen to the views of others. Is it any surprise that the Spastics Society, Age Concern, the Royal Association for Disability and Rehabilitation, the Scottish Society for the Mentally Handicapped and many other organisations are shocked by the Government's decision and the manner in which it was announced? Is it any surprise that Sir Brian Rix of MENCAP has said that it was a disastrous decision? Grass roots members and supporters of these organisations, and the 6·5 million people with disabilities and their carers—the blind, deaf and elderly people with disabilities who cannot express their views and who believe the Government's promises of choice and independence in which advocacy plays a vital part—are equally appalled. Mary and Albert Coyle, constituents of mine, know that their son Gerard, who is 36 years old and mentally handicapped, will not now have the advocacy, representation and assessment which they thought he had been promised by the House and which they saw as crucial to the future of their child and to that of many others suffering from mental handicaps.
The House will return to these issues, but before those major debates take place—the issue will not go away—it is only right that the anger of such people should be expressed today. Millions of disabled people and their carers want the House to express its repugnance at an exercise in intellectual arrogance and abuse of temporary power by the Government which must be rejected.

Mr. Alistair Burt: No matter how often we debate the national health service and whatever our debates are ostensibly about—whatever reforms and new ideas may be under consideration in the motion—they always seem to resolve themselves around two arguments advanced by the Opposition. First, they say that they should be trusted with the health service because they always spend more than the Tories ever could or would want to. Secondly, they draw attention to the way in which, as they see it, the Tories have looked after the health service, claiming that that is evidence of that fact that the Tories reform plans will fail and that the Opposition would do everything better.
We can bandy statistics across the Chamber until the cows come home; we can use global statistics which people may or may not choose to believe. But by examining what happens in a local district health authority we can start to peel away some of the falsehoods and see what has actually happened. In doing so, we can see that the two arguments on which the Labour party relies are false and useless.
Let us relate the first argument, to do with Labour's expenditure, to my constituency of Bury. The only time when expenditure on the NHS in Bury has fallen was under a Labour Government. Between 1974 and 1979, it fell by 2 per cent. Bury had needed a new hospital for about 100 years. It was the only part of the north-west district that had not had a new general hospital in 100 years, but one could not be built under Labour because of reductions in capital expenditure.
Those cuts in expenditure and that way of looking after the finance of the health service was mirrored elsewhere in the country. Under the Conservative Government NHS funding as a proportion of GDP has grown twice as fast as it did under Labour. So there is no argument about finance. There has been no greater or longer lasting deceit practised on the British people than the Labour party's claim that funding is better under a Labour Government.
Labour's second argument is that the way in which the Tories look after the NHS shows just how much we care. In answer to the hon. Member for Monklands, West (Mr. Clarke), who believes that we live in a world of our imagination, I shall read out some facts about the Bury district health authority. If the hon. Gentleman thinks that they are in my imagination he can come to my constituency, talk to the consultants, ring up the district general manager and query any one of the facts that I shall spend about four minutes reading out.
The past 10 years or so have seen substantial developments in the services provided by Bury health authority. Those developments have affected almost every sphere of activity and that momentum is set to continue in the foreseeable future. There has been a massive increase in the funds made available, and at the same time the authority has been praised for the high quality of service provided.
The improvements include extra doctors in hospitals. There has been an increase of 43 per cent. in the number of doctors employed, and the additional consultant specialists appointed include those in accident and emergency, anaesthetics, paediactrics, obstetrics and gynaecology, radiology, geriatrics, psychiatry, pathology, ear, nose and throat, adult health and orthopaedics. Those people exist. They are flesh and blood. They can be met, touched and spoken to. They are not figments of my imagination.
In the past decade the number of nurses in Bury has increased from 875 to 1,181. There has been an increase of 45 per cent. in professional and technical staff such as physiotherapists and occupational therapists, from 145 to 214.
As for capital expenditure on buildings and the like, during the past 10 years or so more than £25 million has been spent on new and improved buildings. They range from new theatres, new wards and out-patient departments to all the necessary support facilities required, such as kitchens and theatre supply units. The new phase 1 development of Fairfield general hospital cost £10 million and provided new wards for the elderly, children and ear nose and throat patients. A new ante-natal clinic was provided together with a new theatre. The developments continue with a current building programme of £2·5 million which was celebrated in the local newspaper under the headline, "Health Service Cash Bonanza". That programme includes a new purpose-designed obstetric theatre which was recently opened by the Under-Secretary of State for Health, my hon. Friend the Member for Loughborough (Mr. Dorrell), upgraded maternity and gynaecology wards costing £1·1 million, upgraded wards for the mentally ill and extensions and improvements to health centres.
In the Bury health authority no beds have been lost for financial reasons. There has been an increase in the number of beds which has led to an increase in the number of people being treated. There has been an increase of 55 per cent. in the number of patients admitted to hospital and a massive increase of 160 per cent. in the number of day patients.
In 1979, the health authority's budget was £12 million, and in 1990 it had risen to £34 million which represents 19 per cent. real growth in contrast with the 2 per cent. loss in real terms which occurred under the last Labour Administration.
I shall read out some figures relating to the number of patients treated. They are all real people. In 1978–79, a total of 17,780 in-patients were treated and there were 1,575 day cases. In 1985 the number of in-patients had risen to 20,778 and day cases to 2,731. This year it is estimated that there will be 27,600 in-patients treated and 4,100 day cases. That represents a total increase in 10 years of 55 per cent. in the number of in-patients treated and 160 per cent. in the number of day cases treated.
In February 1990 there were 1,303 people on waiting lists in Bury. By February 1991 that figure had reduced by 300. The numbers waiting between one and two years in February 1990 was 104. In February 1991 that figure had decreased to seven. In 1990 the number of people waiting more than two years for treatment was 36. In 1991 that number had been reduced to zero.
I am sorry to have taken five minutes to quote all those figures to stress that no party or Government intent on destroying the health service would provide a district health authority with a record such as that. There is no evidence in my health authority to suggest the lack of care on which the Labour party based its argument. All the efforts that have produced improvements in my constituency, the ethos behind them and the competitive tendering which has produced money that has gone into patient care have been fought every step of the way by the Opposition. That is how much they care about the health service. Their attitude is to say, "Leave it as it is. It is all right. It does not matter. Trust us."
It is sad that we spend our time tossing jibes to and fro to deal with the falsities put about by Opposition Members when we know the truth. There is only one health service; it has its good parts and its bad parts. It has its problems, and it has people who wait too long for treatment. It has bad hospitals that need tidying up and people who travel too far, but, above all, it has a dedicated staff who want to improve it. There is no mileage for anybody, whether they are doctors, administrators or politicians, in making things worse. Many people put in a lot of time and effort. Those who work in the health service, whether they are GPs like my father or hospital doctors like my brother, resent the continual efforts that are made to denigrate and run down the health service. The Opposition do not appreciate that that goes home to people who are working in the health service and trying to improve it.
We should spend more time talking about matters that the community health director in Bury dealt with in his excellent annual survey. He wrote:
lung cancer and coronary heart disease…are the consequence of an unhealthy lifestyle and many potential years of life are lost because of socially acceptable lifestyles committed to cigarette smoking, an over-indulgence of alcohol, promiscuity, etc. The effects of such lifestyles even threaten and prejudice during pregnancy the chances of a healthy fit baby. Whilst on the one hand we spend vast sums of money as a nation treating or subsidising the effect of these diseases we also, as consumers, spend equally vast sums of money encouraging the habits—albeit with health warnings".
We should be talking more about preventive medicine and the things that really matter.
In conclusion, it is rather sad that when we have a Government with a national and local record in the health service such as I have described, and when we have the efforts that the Government have put in, we have at the same time a cynical Opposition who cannot even bring themselves to spit out through clenched teeth any acknowledgment of success and instead commit themselves to twisting the facts and pretending falsely and pathetically that under some new red dawn everything will be put right.

Mr. David Hinchliffe: I made the mistake of blinking during the Secretary of State's half-hour speech, and Missed his reference—which cannot have been more than one sentence—to community care. I thought that the debate was concerned with the health service and community care, and I am sorry that the Secretary of State has such contempt for the important issue of community care that he could not be bothered to refer to it in some detail.
An answer that I received from the Under-Secretary of State for Health on 24 January said:


We are firmly committed to a policy of community care which enables elderly and disabled people, with appropriate support, to live in their own homes or in small homely settings in the community for as long as this is feasible and sensible." —[Official Report, 24 January 1991; Vol. 184, c. 295.]
Frankly, the Government have an excellent record on words about community care, but their deeds are different. Their record on community care is shameful.
I wish to stick to the question of community care because, with the honourable exception of my hon. Friend the Member for Monklands, West (Mr. Clarke) and the Labour Front Bench, it has not so far tonight received the attention that it deserves.
During the 12 years that the Government have been in power, they have operated a programme of emptying the large psychiatric hospitals. There has been a reduction in the number of homes for children and for mentally handicapped people and in the number of geriatric wards. The Government were committed to reducing institutional care but, at the same time, there has been a distinct revival of the institutional model of care in the private sector.
During the last 10 years, there has been a 4 per cent. reduction in the number of places in local authority homes for elderly people. There has been a 316 per cent. increase in the number of places in private residential care homes. In my area of Yorkshire, there has been an increase of almost 1,000 per cent. in the number of private nursing beds. The argument is that the number of elderly people has increased but, according to the Library, the number has increased in the same period by only 9·5 per cent.
The Audit Commissioner told the Griffiths committee that a quarter of the people living in private care homes could have been accommodated in the community with the appropriate support. Only a few weeks ago, evidence was given to the Select Committee on Health by a series of directors of social services who said that, in their areas, about 50 per cent. of the people living in private care homes could and should have been accommodated in the community with the appropriate support.
The Government's record is one of placing in institutional care people who do not need and do not want to be there. They are the Government of institutions, who are in no way committed to genuine community care which involves caring for people in their own homes and neighbourhoods.
It is interesting that the Government have pursued policies geared to reducing the support available to people who wanted to live independently in the community. My hon. Friend the Member for Monklands, West referred to the appalling treatment of his much valued Disabled Persons (Services, Consultation and Representation) Act 1986. If we consider the Government's record on local authority personal and social services, it is clear that they have pulled the rug from under the feet of people who wanted to remain at home and be independent. Underfunding of the national health service means that supportive health services such as district nurses and bath attendants have been withdrawn from people who wanted to remain at home but were forced to enter into care.
There have been huge reductions in the rate support grant. I asked the Library for an estimate of the reductions in that grant during the administration of the present Government as far as they affected the personal social services. I was staggered to learn that the reductions in the budget from the 1979 level of local authority expenditure on personal social services total about £6 billion. The

Government say that they are committed to community care, but they have taken from local authorities that £6 billion, which should have been spent on home help services, day care services, meals on wheels and a range of supportive services which should be available to enable people to live independently in their own homes. My area has suffered as much as any other.
There is a problem with the nonsense of the standard spending assessment. I have spoken to Conservative Members who do not understand how the SSAs are worked out. Last year, Wakefield social services spent £4·5 million above its spending assessment. If it had had to abide by it, it would have had to reduce services drastically, scrapping provision for child protection in some instances. This year, it is £3 million above its SSA. Yesterday, I asked the deputy director of social services to tell me what it would mean if the authority had to cut that £3 million. It could mean closing four homes for aged persons and two children's homes, and reducing by 10 per cent. a fundamental part of community care—the home help service.
Alongside such cuts at local authority level in community support for elderly and disabled people, the Government have pressed money hand over fist into private institutional provision, in a huge explosion following the extension of supplementary benefit payments in 1981. When I see broadcasts by the Conservative party like that last week saying, "How much does a Labour councillor cost you'?", it makes me think, "How much does a Conservative councillor cost you?" He cuts the home help service, day care centres and meals on wheels and ends up driving elderly or disabled people into private institutional day care, at a huge cost to the taxpayer. That is what a Conservative councillor costs us.
There should be a huge redirection of resources away from institutional care into independent living in the community. We must ensure that, when the new Labour Government come to power shortly, we turn on its head the central thrust of this Government's community care policy, which has been to push people into institutional private sector care.
We must transform residential care from the present warehousing provision that exists in so many private care homes. There must be more sheltered housing to give people semi-independence facilities if they need some care provision. Crucially, there must be a substantial redirection of public resources away from residential care into preventative provision within the community.
There is a need for a progressive reduction in the income support budget and the redirection of that budget to local authority community services, to voluntary organisations and to health authorities to fund a massive expansion in support and assistance within the local community.
Only today I obtained some interesting figures from the Library. I asked specifically how much money had been spent on income support to individuals going into private care homes during the past 10 years. I mentioned that the Government had removed £6 billion in personal social services funding from local authorities, thereby reducing the services available to people in their own homes and forcing them in many instances into care. The figures provided by the Library show that the amount spent on income support for people in private care homes during


that period is roughly equivalent to the £6 billion spent in putting people—many of whom do not need or want to be there—into private institutional care.
Unlike the Conservative Member who accused the Labour authorities of throwing money at a solution, I believe that public resources are going in the wrong direction. The Government are spending money on the wrong things, and it should be completely redirected. I am talking not about huge additional costs, but about the appropriate use of existing resources. When talking about health or community care, we must deal above all with the human cost of the failure to enable individuals to retain self-determination, their independence and their pride.

Mr. John Butterfill: The hon. Member for Wakefield (Mr. Hinchliffe) knows that I share his concern for community care and the provision of social services. He has perhaps done the House a disservice by suggesting that spending on social services has decreased under this Government. During the past 12 years, spending has increased by 52 per cent. and, at the same time, there has been a massive increase in expenditure through income support for those who are, sadly, resident in old people's homes. During the lifetime of the Conservative Government, that expenditure has increased from £10 million to £1 billion. There is no question but that resources are provided. It is sad that the Labour party constantly suggests that the Government do not care and do not provide money. The reality is different.
The Labour party's latest policy document suggests that a Labour Government would massively increase the resources available to the national health service. Clearly the hon. Member for Derby, South (Mrs. Beckett) does not believe that the health service is a spending priority and she is unlikely to provide the necessary money, even if Labour can find it.
No one believes that the Labour party is not sincere in wanting to improve the health service, but its record must speak for itself. When Labour was last in power, waiting lists increased by 48 per cent., the hospital building programme was suspended and in real terms doctors' pay decreased by 14 per cent. and nurses' pay by 21 per cent. The Labour party's ethos is that it cannot manage the health service efficiently; it concentrates its well-meaning efforts on the wrong items and it does not deliver the goods to the public.
The few reforms the Labour party has come up with recently—such as getting rid of competitive tendering, which will cost £135 million, and bringing in a statutory minimum wage, which will cost £500 million—will do nothing for the health service except increase costs. The money that the Labour party proposes to spend on statutory minimum wages alone would be the price of 20 district general hospitals.
I should willingly give way to the hon. Member for Birmingham, Perry Barr (Mr. Rooker) if he will say which 20 hospitals he will close to pay for his daft minimum wage proposals. Or will he create the money out of thin air? He could not create it before. The hon. Gentleman will not rise from his seat.

Mr. Hinchliffe: rose—

Mr. Butterfill: If the hon. Gentleman will excuse me, I shall not give way generally, because of the tight time limits. I should willingly give way to the hon. Member for Perry Barr, but he does not seem anxious to take up my offer.

Mr. Jeff Rooker: There would be one fewer speaker on the Conservative Benches.

Mr. Butterfill: Does the hon. Gentleman wish to intervene? It seems that he does not.
Expenditure increased from £8 billion under the Labour Government to £32 billion under the Conservative Government. Nowhere is that more apparent than in my constituency of Bournemouth, West. Under the last Labour Government, East Dorset health authority was starved of resources. It did not get new hospitals. A socialist chairman of Wessex health authority decided that all new hospitals would go to socialist-controlled areas —Basingstoke and Southampton, which fortunately are no longer socialist-controlled—and we got nothing. East Dorset had virtually the lowest per capita expenditure in the country.
Since then, my constituents have seen the benefits of what has happened under the Conservative Government. There is a brand new general hospital, the first phase having been completed and the second being under construction. There is a massive new extension to St. Ann's, our hospital for the mentally ill. New operating theatres have been provided for the marvellous Westbourne eye hospital in my constituency. Perhaps most important, many new facilities and new wards have been built at the psycho-geriatric hospital at Alderney. All those developments are tangible. My constituents can see them and they demonstrate more clearly than anything else could the Government's commitment to the national health service. My constituents did not see those developments under a Labour Government.
My constituency has double the average number of elderly people, creating enormous difficulties for my health authority in particular. The elderly sector is the most expensive sector to maintain in the health service. Under the last Labour Government no special consideration was given to the funding needed, but under the Conservative Government a special factor was introduced in calculating funding for areas such as mine. Because there are more over-85-year-olds in my constituency than almost anywhere else, we get far more money than we used to get for them.
The evidence can be seen in the psycho-geriatric hospital. New wards were built to bring into the hospital people who cannot cope in their homes but would like to do so. There they can be re-trained, taught to be independent and shown how they can manage for themselves. With the help of social services, which have an enormously increased budget, those people have been able to live useful lives in their homes after a limted stay at hospital. New respite care facilities have been provided in hospitals so that carers—to whom I pay tribute—can have a break from looking after their elderly dependent relatives and elderly people can be cared for better and taught how to be more independent in their homes. All that is happening in my constituency under a Conservative Government. We have nothing to be ashamed of.
One of the problems of the success that we have had with the NHS is that people are living much longer, with


a corresponding increase in Alzheimer's disease. That appalling disease creates misery for the sufferers and, more particularly, their families. I believe that there has been a breakthrough. Encouraging trials are under way into a new drug to treat that awful disease. The trials seem to show that the drug will arrest the disease and improve the condition of existing sufferers. I should be grateful if my hon. Friend the Minister for Health would say something about that drug and how soon it may be generally available on the market.

Mr. Geoffrey Lofthouse: I wish to raise a problem in Yorkshire which is nothing short of a scandal. Although I do not expect the Minister for Health to answer me in detail, I hope that she will assure me that she will investigate the scandal and reply later.
Earlier in the debate, I drew the attention of the Secretary of State to what happened in Yorkshire this week. Like many others, we who live in the Pontefract health authority area have problems with waiting lists, and there are many tragic cases. In 1986–87, Pontefract health authority used some of the waiting list money that it received from central Government. After the authority had decided on a scheme to take 500 patients off waiting lists, consultants at a hospital refused to operate the scheme. The authority had to transfer the money to a private hospital. Slightly over 200 operations were done, whereas 500 could have been done at the NHS hospital in Pontefract.
It came to my notice last Monday that a team of five consultants and four senior managers from the Pontefract area health authority—that means from Pontefract general infirmary—were to visit three hospitals in the United States. The health authority says that the visit is in order to gain experience in issues such as quality of health care, organisational structures, American experiences in contracting and diagnostic grouping for the costing of services—I do not know what that means. The trip is to last eight days and is funded by a separate allocation from the regional health authority. I do not know what that fund is. Perhaps it is set aside to send top health officials and surgeons to America to study medical practice.
What use can be served by consultants studying American management practice? The House will recall that, in response to my intervention, the Secretary of State for Health said that he could not see any useful clinical purpose in surgeons going to America. But they have gone.
To date, we have been unable to find out the cost of that trip or whether other health authorities in Yorkshire have also sent people on it. However much such trips cost, surely the money could be better used. I do not believe that any hon. Member would support spending money to send health service staff to America to study private medicine. We are led to believe that, because the Pontefract health authority, from senior medical staff down, has never been enthusiastic about opting out into trusts, it is now being encouraged to participate in a junketing trip so that it will change its mind and show interest in opting out. If that happens in Pontefract, it will be fought all the way.
We must consider the fact that there are still great problems with staff grading. Many nursing staff feel that they have not been graded to the extent to which they are entitled. Many workers in the health service in Pontefract

are not being paid in accordance with the work they do. The money that is being spent on such trips could be spent in many other areas. The security aspect is a problem in health authorities throughout the country. Something must be done about paying more attention to security. We must not forget the tragic case in Wakefield involving two consultants.
I have visited the Pontefract general infirmary several times to visit a couple of friends there, so the information that I give the House is not a trumped-up journalist's story. I give the facts. I visited a surgical ward as recently as last Sunday. In the day room, where many elderly and middle-aged patients who had undergone surgery were hoping to watch one of the semi-finals of the Challenge Cup, the patients told me that the television had been out of order for six weeks and that they had been issued with a small one that did not work very well.
Broken chairs were piled up in the corner of that small room and I was told that they had been there for six weeks. Some of those men, who were still carrying catheters around and suffering discomfort, could not find enough chairs to sit down. In another ward I was told by patients, supported by staff, that in the evening they were unable to have a drink of tea, coffee or Horlicks because their budget did not allow them to buy enough milk. I am not making a political point but stating facts. That is happening in an authority that can send nine people off junketing to America.
I do not expect the Minister of State to answer in detail but she should investigate what is happening and say where the money has come from and why people have been sent to America. What damage will be done to the people in my area who are on waiting lists—the most recent figure that I have seen is some 2,000 people waiting for general and major surgery—when five surgeons have gone away for eight days?
Like many other hon. Members, I could relate many cases that have been put to me by constituents. I am sure that Conservative Members must receive complaints from their constituents. The other day, a constituent who came to see me was worried that his wife had been waiting for a hip operation for 14 years. She had been transferred from Pontefract to St. James's hospital—that marvellous hospital in Leeds—two years ago. [Interruption.] It is no laughing matter. That is the information that I have been given. She was then told that she must wait two years and that she would be operated on in 1991. However, she has now been told that, because of the Gulf war, she will have to wait for another 12 months.
I sincerely hope that the Minister will investigate what I believe is nothing short of a scandal if the health authority is sending people to America when money could be put to much better use.

Mr. Anthony Coombs: It is a sad reflection on the almost total bankruptcy of constructive thinking among the Opposition that we have had not only a speech by the hon. Member for Livingston (Mr. Cook) that contained not a single constructive or positive idea on the Labour party's plans for the health service, but also an unimaginative, centralist and possibly even mendacious motion put forward by the Labour party today. I agree with my hon. Friend the Member for Bury, North (Mr. Burt) that many people who work in the health service


resent the talking down which their service and the high standards that they so often produce always seems to receive from the Opposition.
I believe that the public have rumbled the Labour party's old argument that it would be the one to pump more resources into the national health service, and the Conservative party has not. That is nonsense. Now the average family in Great Britain spends about £44 per week on the national health service; under the Labour Government it spent £11 per week. In real terms, the amount of resources going into the health service has risen by about 52 per cent. in the past 10 years. Under the last Labour Government it went up by 6 per cent. in four years —about one third as fast. As we have heard, one —year1977–78—saw the only cut in real resources to the health service in the past 10 years, and it was made by a Labour Government.
When I ask most consultants, they say that the facilities, such as instruments and operating theatres, with which they have to work have improved. They should have done so during the past 10 years when there has been an increase in capital expenditure of 62 per cent. in real terms under the Conservative Government. Under Labour, expenditure fell by a third in just four years.
I will translate what that increase means to my constituents. They have not only acquired a new hospital at Bewdley road in Kidderminster but, starting this autumn, there is to be a £6 million extension to our hospital, which will provide improved geriatric, obstetric and pathology facilities. I do not call such measures cuts —they represent significant investment by the Government.
The Labour party talks about beds as though the national health service were a furniture business. Beds are provided to treat patients. Under the Government 1·2 million more patients per year have been treated in hospitals than under the Labour party as well as double the number of day cases. People talk about closing beds, but last week district health authority consultants told me that the new capital investment for geriatric facilities had enabled us to close an antiquated, old fashioned Victorian building in Mill street which presently provides geriatric facilities for patients. I cannot wait for that facility to be closed. I make no pretence about it—the investment will provide a better deal for my geriatric constituents.
Nurses often have to hear their service being talked down, but there are 60,000 more of them than there were in 1979. Their average hours have dropped from 40 to 37·5 per week. They receive better training through Project 2000 and their pay has risen by 41 per cent. in real terms after taking into account price increases. Under Labour, the nurses received worse training, worked more hours and their pay dropped 25 per cent.—it bought 25 per cent. less during the last four years of the Labour Government. I do not think that Opposition Members have any lessons to teach us about managing the health service.
The hon. Member for Livingston has consistently been trumped by the Government, even when he merely asked for extra resources. I understand that last year he called for an injection of £3 billion into the national health service to make up what he regarded as lost resources. We have put in £6 billion over two years, and that investment will continue. Professor Le Grand, who has already been

mentioned, is a socialist adviser to the Labour party. He said that it would be difficult to imagine that Labour could have done much better in terms of resources. If he says that, with his ideological commitment, it shows that the Labour party could not have done any better.
The most depressing factor is that the Labour party do not even seem to understand that if one tries to organise a service as big as the national health service from the top down, one is likely to make the decisions and efficiency of that service worse. That has been the case in eastern Europe. That policy makes it impossible to allocate costs properly and is likely to create greater waste and significant differences in efficiency—that has occurred between district health authorities in terms of ancilliary and administration staff.
I welcome the internal market because it will give more flexibility to local hospital managers to be able to manage properly according to local needs. It will give GPs more leverage to demand higher standards on behalf of their patients. It will identify the costs of providing treatment so that there will be a better resource allocation system than merely deciding what was spent the previous year plus a percentage. It will allow us to plan for patient needs. Therefore, it will give better patient care at any level of funding. That will be the result of the internal market and the Government's policies.
It is early days, but I shall spend a few minutes talking about GP fund-holders in my constituency. I anticipate that by the end of the year no less that 65 per cent. of my constituents will be treated by GPs operating a GP fund-holding practice. That shows the extent of the enthusiasm with which GPs have taken up the idea in my constituency. It is ironic that the three largest practices to have taken it up included the most vociferous critics of the idea when the Government mooted it last year. It has enabled them to give and demand higher standards in hospitals to and for their patients. I know that one of the GP practices already provides weight clinics, well person clinics, diabetes clinics and glaucoma clinics. As a result of being a GP fund-holder, the practices are also likely to provide further facilities for osteopathy, parentcraft and even alternative medicine.
It is not surprising that Doctor magazine states:
Although it is easy to be cynical about health matters, there is no doubt that much of the health promotion now proliferating within general practice is doing a power of good.
It is doing a power of good because it gives GP fund-holders and other GPs more control over their budgets and the way they do things. That is not to say that matters could not be further improved.
I should like to see the smaller GP practices with fewer than 9,000 patients given the opportunity to be fund-holders and the ability to charge hospitals for minor operations, which would take the weight off hospital casualty departments. Eventually, I should like GP practices to be given a greater control over their budgets than the 3 per cent. they currently have. But we have taken a step in the right direction because the GPs are a dynamic part of the system. They are the patients' advocates and are nearest to patient demand. That is why they will not just demand better services or just be a spur to efficiency in NHS hospitals but, most of all, they will provide a rational data base so that planning in the health service can be done


on the basis of actual demand and costs of a district rather than supposed costs worked out by a bureaucrat in a regional health authority or in Whitehall.
According to the British Medical Journal and the King's Fund, as a result of the national health service reforms decisions on resources will go away from the private domain of doctors and into a more public arena. That can only be good for efficiency and the national health service. Sadly, the Labour party is too purblind to understand that the flexibility and better costing which are integral to the internal market are not a substitute for a good national health service but crucial to it. I support the Government's amendment.

Mr. Jim Cousins: I add my tribute to those paid to my hon. Friend the new hon. Member for Neath (Mr. Hain) on his compelling speech. He is at that blissful stage in his parliamentary career when we all tell him that we shall hear a lot more from him. He may not realise that he will have to hear a lot more, from all of us.
One point that has been made by Conservative Members is that the Labour party does not understand management and efficiency. I have available to me the purchasing contract system of the Newcastle district health authority. I discovered that the new, more efficient, better managed system will include an unspecified number of purchasing review teaMs, at least five new professional forums—whatever they may be—five quality assurance committees and at least six different audit systems—all within the one purchasing authority of one district health authority. One of the greatest weaknesses of the new system is that, because it has not been tested, the purchasing side is far too weak. Even with all the gimcrack bureaucracy that I have just described, it will stay. People who are already in the system confess that it is weak.
I have in my hands the business plan of the North Tyneside family health services authority. It tells us that, as a contractor, it feels its position to be weak because it cannot define standards. It cannot generate competition between contractors, because it does not have sufficient authority to locate contractors. It also tells us that it has no managerial or contractual relationship with practice-based staff.
The Secretary of State has already admitted that the new system he has created will be not a true market but a managed market. I do not know whether that means that the Secretary of State is one of those people whom the right hon. Member for Chingford (Mr. Tebbit) referred to as saboteurs. If it is to be a managed market, considerable deficiencies can already be seen within my own health authority. We have discovered that the managers of self-governing trusts have already awarded themselves pay rises of between 30 and 80 per cent. and that they have announced that the true extent of that pay rise is secret and commercially confidential.
We have already discovered that a 75-year-old woman has been told that because the waiting list for cataracts is so long she cannot be added to it. She cannot even go on the list as a statistic. We have already discovered that the radiotherapy and chemotherapy departments of one general hospital have not been provided with funds for new cancer drugs and the means to deliver them, and that special arrangements have had to be made to underpin

that service. We have already discovered that a dermatology service will be so reduced, under the new system, that the consultants in charge of it have been told that they can have just one office in which they may choose from time to time to put four beds. We have just discovered that no provision has been made in the dental hospital for purchasing the contracts for patient services. That is the reality of the new, so-called "managed", market.
The real damage that the Government will do to themselves under the new system was referred to by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). He mentioned the public health needs planning system. Not a single Opposition Member of Parliament disputes the need for a public health needs planning system, but I wonder whether Conservative Members have a clue about the information that that will produce, or of how devastating it will be.
The northern region has hardly started its public health needs planning system, but it has already discovered that 330 of the babies born in November 1989 died unnecessarily before reaching the age of one because our health performance standards are worse than the national average. It has already produced information that 40 per cent. more women die of cervical cancer in the northern region than in the nation as a whole. It has already told us that, of those women who will die unnecessarily, 10 times more come from the families of unskilled manual workers than from the families of the professional and managerial classes. The Government will have to address those devastating new needs. I doubt whether they are prepared to take on board the means that will be needed to deal with those problems.
As for the new annual report, we called years ago for such a report, but nothing was done about implementing the recommendations of the Acheson report. We are told that many more people die prematurely in the northern region, week by week, month by month, year by year, than almost anywhere else in the country, and that the best years of the lives of far more people in the northern region than anywhere else in the country are ruined by disease and disability. Neither the Secretary of State nor those Conservative Members who have spoken in the debate even hinted that they are willing to take that information on board and do something about it. I see no sign that their complacency about the new system that they have just devised has been punctured.

Mr. Peter Thurnham: The hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) referred to a lady who had been kept waiting for a cataract operation.

Mr. Cousins: Her name had not even been put on the list.

Mr. Thurnham: She was kept waiting, yes, to be put on the list. He referred to the realities of the situation, but he seems to have forgotten that last year 92,000 cataract operations were performed, compared with 40,000 when his party was running the national health service. He should be pleased about the reforms. I am convinced that they will lead to an increase in the number of cataract operations.


Now that hospitals are being asked to quote figures, we see huge variations in the costs of operations as between different hospitals. There are also wide variations in the waiting times for operations in different parts of the country. The reforms should lead to a much improved service and to a considerable increase in the number of cataract operations.
I am sorry that the hon. Member for Monklands, West (Mr. Clarke) is not here. I share his impatience. I believe that he had the sympathy of the House when he referred to the 1986 Act, which he introduced. However, he was wrong to criticise the Government for what he called a U-turn. His Act will, in time, be implemented. We should not forget that there has been a massive increase in spending on the social services under this Government. During the last 10 years it has increased by 52 per cent.
It was the speech of the hon. Member for Livingston (Mr. Cook) that disappointed me most. He said nothing about his party's proposals. He failed to give any firm commitments. He said that £2·8 billion could not be found overnight. The Government have increased spending by £3 billion during the last year. I do not know what he is offering.
The hon. Gentleman referred to NHS waiting times. The longest waiting time in the NHS is the time that we have been waiting to hear what he has to say. I sympathise with his difficulties. The Labour party is giving a low priority to the NHS. It says that child benefit, pensions and education are its top priorities, so spending on the NHS is not a top priority; therefore he cannot come forward with any proposals. His party's record is very poor. Capital spending, the proportion of gross domestic product spent on health, pay for nurses and doctors, on the increase in the number of in-patients treated each year, on waiting lists, and on NHS revenue funding—all have been far better managed under this Government than they were under the Labour Government. The hon. Gentleman is in a predicament. He cannot look back and he cannot look forward, because his party does not believe that the NHS is a top priority.
What upset me most about the hon. Gentleman's speech was his unwarranted attack on charities. Is this a new Labour party policy? Perhaps he will advise the House. It will be interesting to study what he said in Hansard. I understood him to say that he did not agree with charities giving money to the NHS. Does he suggest that when, or if, we ever have another Labour Government he would not allow charities to contribute to the NHS? My experience is that people like to give money for hospital equipment. They gain satisfaction from doing so. It is only the trade unions—the hon. Gentleman's bosses, I guess—who do not like charities. They believe that they are a threat to trade union restrictive practices.
I am disturbed by the contrast between the successful way the Government are running the NHS and the problems encountered over the delivery of social services at local level. The people in my constituency can look forward to the provision of a new hospital. The plans are coming through and work will start in the spring of 1992. The cost will be £13 million. We have been promised an increased share of North Western regional health authority revenue. For too long, Bolton has been the Cinderella. For too long, it has been at the bottom of the

league table—19th in the district. Now, not only is an increased proportion of gross domestic product spent on health care, but there will be an increase in expenditure on Bolton itself.
Like other hon. Members, I welcome GP fund holders in the constituency. Two of the major practices have embraced the idea. That spirit of reform has been adopted very strongly in the area, as well as by Christie hospital, and Central Manchester hospital, which are both going for the new trust status. I welcome the extra funds that are being made available for mental handicap units. In my constituency, there are plans for such a unit. My hon. Friend the Minister for Health has been to Bolton and has heard plans discussed. I know that the health authority is working on a proposal for a new 18-bed unit to provide residential and respite care. I look forward to that coming to fruition.
I am disturbed by some failures and problems created by local authorities—too many of which are controlled by Labour—in their attempts to deliver services of a high standard. In Bolton at the moment there is much unrest among social security staff. There are threats of strikes or working to rule. It all reminds one of Labour's winter of discontent, which was the cause of so much dissatisfaction during the final year of the Labour party's last term in office.
Local authority residential homes and neighbourhood network homes involve excessive costs. There are delays in assessing the needs of the handicapped. Indeed, that applies in many local authority areas. Some local authorities, including those in Bolton and Salford, are failing to take up the mental health grant—money provided by the Government. Then there is the terrible dissatisfaction throughout the country with the way in which social workers, who are supposed to protect children, have been removing them in dawn raids from their innocent families. That has destroyed to a considerable extent the confidence that people ought to have in the way in which social services departments are run. I realise that social workers have a difficult job, but they have been given guidance in the shape of the Butler-Sloss recommendations. The situation is very disturbing. It makes one wonder whether there should not be wholesale changes in the way in which the social services are run.
A particular aspect of social services work with which I have been concerned recently is the adoption of children from Romania and other countries. I am very concerned at the attitude of the official spokesperson of the Labour party on children, the hon. Member for Eccles (Miss Lestor). I believe that in her opposition to the adoption of children from Romania and elsewhere she is quite isolated. Her attitude is in complete contrast to what was said by President Iliescu of Romania when he was here yesterday. He said that he welcomed the help given by United Kingdom couples who are willing to adopt Romanian orphans. He told us that there are still 170,000 children in institutional care in Romania, and that couples wanting to adopt are welcomed. That is contrary to advice issued by some social services departments. I hope that my hon. Friend the Minister for Health, who has been so sympathetic in encouraging couples who wish to adopt, will take note of what the Romanian President said. He hopes that British couples will not stop adopting as a result of changes occurring in Romania. I hope that my hon. Friend will be able to make that fact clear to social services


departments that have been advising couples that no adoptions can be done at the moment. On the contrary, there is a great need for adoptions to continue.
I hope that my hon. Friend will find the recent formation of the British Advisory Board on Inter-Country Adoption to be of some help. That should result in the provision of very good professional advice to Government Departments, Members of Parliament and other interested people. The advisory board consists of virtually all the leading professional people concerned with the adoption of children from abroad. It has been set up under the chairmanship of Margaret Bennett of the International Bar Association, who will be involved in the forthcoming Hague convention discussions.
A few moments ago, I talked about the difficulties in social services departments. I hope that, in her winding-up speech, my hon. Friend the Minister for Health will give a little thought to whether some of the functions of the social services department might be transferred to the local health authorities. There is a difference in attitude. People employed by local authorities tend to like to work from 9 to 5, Monday to Friday, whereas many of these services are required 24 hours a day, seven days a week. I believe that these services could be provided much more sympathetically and competently by the local health authorities than by the local social services departments, many of which have demonstrated incompetence and have lost the confidence of the public.

Mr. Deputy Speaker (Mr. Harold Walker): Order. The hon. Gentleman has run out of time.

Mr. Eddie McGrady: I am grateful for the opportunity to participate in this debate. It is 40 years since the inauguration of the health service as we knew it. Perhaps complete revitalisation, revision and overhaul are somewhat overdue, in view of the obvious changes in circumstances, in medicine and in technology. But there is one thing that never changes, and it forms the basis on which the health service was originally created—to provide equality of health care and of medicine to all citizens. In other words, citizens were to be treated equally. Let us hope that the target of a Government of any party would be care of high quality, particularly for those people who cannot care for themselves.
In January of this year, the Health and Personal Social Services (Northern Ireland) Order was passed in this House late in the evening, after a debate lasting just an hour and a half. That is the extent to which we from Northern Ireland were able to participate in the discussion of legislation affecting ourselves. No account whatsoever was taken of the differences between the manner in which services are rendered in Northern Ireland and the manner in which they are rendered in Britain. Over the years, services in Northern Ireland evolved in a slightly different direction. Communities in Northern Ireland are much more closely related, and services much more harmonised, than is the case here.
For instance, general practitioners, local hospitals and professionals involved in the provision of social services and community care have been very closely linked and identified with each other. No attempt was made to take into account that very valuable asset. With the new order, the link between one section and another went out of the window. The new structures that have been set up have

diminished that facility. The order concentrated on financial restriction and administrative structures, in respect of both hospitals and doctors.
I am not in a position to make a critical analysis of medicine or of the provision of medical care, but, as a public representative, one sees what is happening. Three major areas will not be addressed adequately under the new regime. First, there is a need for greatly increased provision for the larger number of elderly and mentally disturbed elderly in the community. Secondly, the new structure does not seem to take into account the obvious necessity to provide more health care for those on lower incomes who, because of financial and other circumstances, often cannot look after themselves. Thirdly, more resources should be devoted to preventive medicine because income levels, educational ability, housing conditions and general social factors make preventive medicine more difficult in some sections of the community. In those three spheres, there will be less adequate provision under the new regime.
The new structure seems to be almost solely concerned with financial restrictions, budgetary control and so-called cost efficiency. There is an administrative nightmare in the hospital and general practitioner sectors. There is a thrust, if not a firm policy, to translate services from the public sector to the private sector as much as possible.
Budget squeezes are affecting all the boards in Northern Ireland. My area is covered by the Eastern and the Southern health and social services boards. It is evident from the new programmes and policies which they have published that the most vulnerable members of the community will suffer under the new regime. Already we have had an announcement of the closure of three homes in my constituency, in contrast to the new buildings which are planned in other constituencies, according to the contributions which I have heard in the debate. In my area, where modest hospital renewal has been planned for some 26 years, it will not be available under the new regime.
I can only draw on personal experience to comment on what is happening. The modest provision of transport for mentally handicapped children in my constituency has been withdrawn. Now they will not be transported from the rural areas of a largely rural constituency to the small towns where Gateway and other bodies provided facilities which gave some respite to their families. The elderly are suffering great deprivation from the lack of facilities which previously were available to them. All that is happening because the budgets of the boards are being squeezed beyond the point of financial efficiency to the point of financial deficiency. Unfortunately, it is the very sensitive sections of the community who are suffering.
Allied to all that in Northern Ireland has been the total abolition of local democracy in the health services. Previously we had district health committees allied roughly to our 26 district councils. They have been reduced to four health service councils. No public representative has been appointed by the Minister to any of those councils, so there is no local democracy. Every member of all four boards is a ministerial appointment. That means that the natural probing which results from local representation will be completely absent from the scrutiny of the councils.
Provision for the mentally handicapped has been reduced locally. Under the health boards in my constituency the priority areas will suffer most. Acute hospital services are being cut. There has been a reduction


in residential and community care, particularly child care. That is happening under the new horizons of the structure that was supposed to lead to better care for the people. When we look back, we will see that there is no longer equality of health care and community care, or concern for the less fortunate.
I have no doubt that the weakest members of the community I represent will suffer most because of their background, income level and education. In Northern Ireland, the social deprivation suffered by some may be even worse than on the mainland because, right or wrong, their local area is designated as subject to some paramilitary influence. Those people who already suffer deprivation, however, will suffer even more because they will no longer receive reasonable health provision and care in the community.
I hope that my interpretation is wrong. I hope that we are now witnessing a new Jerusalem in terms of health and social security. I am not arguing statistics, nor do I seek to argue as an expert in medicine or administration, but my experience means that I know that the people I represent are not getting the health provision they received in the past and to which they are entitled now and in the future.

Mr. John Marshall: I listened with interest to the speech of the hon. Member for Livingston (Mr. Cook), who should have come to the House to apologise for the consequences of his ill-informed campaign against reforms in the health service. His misleading campaign of disinformation and distortion caused unnecessary suffering to many elderly and ill. Was it the act of a caring man to arouse such unnecessary fears among the elderly and the sick or was it the act of an opportunist?
Typical of the distortion that has been offered by the hon. Member for Livingston and his hon. Friends is the implication that, once hospitals have become self-governing trusts and opted out of the NHS, those people must somehow pay for the treatment they will receive in those hospitals. The Opposition should accept that those hospitals are opting out of the bureaucracy of the NHS, but that they are not opting out of the principles that have underlain the NHS since 1948.
Everyone who goes to a self-governing trust hospital will still receive free treatment, but they will also find that those trusts, such as the Royal Free hospital which serves patients in my constituency, will be more responsive than in the past. It is significant that the sponsors of the trust at the Royal Free have made a commitment to reduce the hospital's waiting list.
The hon. Member for Livingston should have come to the House with a great sense of humility, because there is no doubt that he lost the battle for extra spending in the shadow Cabinet. It-is not sufficient for the hon. Gentleman to tell the House that health service spending is top of the Labour party agenda, because we know that agenda as a result of the draft Budget produced by the right hon. and learned Member for Monklands, East (Mr. Smith). Although it offered more spending on child benefit, there was not a penny more for the health service.
Yesterday, an Opposition Member spoke about a hospital closure in Liverpool, and today we heard about a

hospital closure in Manchester. They claim to oppose such closures, but they should tell the House what hospitals they would close in their place.

Mr. Hinchliffe: Why?

Mr. Marshall: Because his right hon. and learned Friend the Member for Monklands, East has already said that there will not be a penny more for the NHS from a Labour Government. The draft budget made that clear, and Opposition Members should argue their case within that constraint.
The situation that would prevail under a Labour Government is even worse than one might expect. My hon. Friend the Member for Bournemouth, West (Mr. Butterfill) has already pointed out that the introduction of a minimum wage would result in an extra £500 million cost to the NHS. To meet the cost of getting rid of competitive tendering, eye and dental check charges and prescription charges, 30 general hospitals would have to be closed.
It is up to the hon. Member for Birmingham, Perry Barr (Mr. Rooker) to tell us whether one of those 30 general hospitals would be in his constituency. Would a hospital in Manchester be closed? How many hospitals in London will be closed by the Labour party? That is a policy to which it is committed.
I welcome the reforms that the Government have introduced. The Labour party is indulging in nothing less than a cynical charade. One does not have to listen to the rhetoric to understand that; one need only look at the record. The last Labour Government cut the hospital building programme by 16 per cent. They cut nurses' pay by 21 per cent. in real terms, and increased hospital waiting lists by 48 per cent. The people will look at the record of the last Labour Government, they will contrast it with the rhetoric of the hon. Member for Livingston, and they will know that the record is the guide to the future.
People can look at the record of this Government, who are treating a record number of patients with a record number of doctors and nurses. That record is in complete contrast to that of the Opposition when they were in power. The reason is that the Conservative party have created a more efficient economy. That, plus the fact that we have caring Ministers, has enabled the health service to improve dramatically in the past 10 years.

Mr. Jeff Rooker: It was a privilege to hear the fulsome tributes by my hon. Friend the Member for Neath (Mr. Hain) in his maiden speech to our late colleague, Mr. Donald Coleman. My hon. Friend gave a graphic description of how the people in the valleys of south Wales have suffered in the past decade. He not only knows how many O-levels he has, but where his home is—and it is now clearly among the valleys. My hon. Friend will be here a lot longer than most of the Conservative Members who heard his speech, and he will be here to play a role in rectifying the neglect of the past decade.
I timed the Secretary of State's speech at about 20 minutes. Less than two minutes of it referred to community care policy, as my hon. Friends have emphasised. He then spent 10 minutes on bluster, attacking the Labour Opposition. Frankly, I am not going to take anything from the intellectual guru behind the poll tax. They can witter all they like, but part of the


responsibility for their 1987 White Paper, Cmnd. 9714, was a direct result of the work of the committee chaired by the Secretary of State for Health. The poll tax has destroyed community care policy, as it will effectively destroy the Government.
The Government-imposed changes in the national health service have created a climate of fear in parts of it and among the staff in some hospitals, one of which I shall name. That hospital is so well-located, geographically, in the centre of a city that it is used by citizens in all areas of the city and outside it. Indeed, parts of north Warwickshire have such a poor public transport system under this Government that it is easier to get to the general hospital in the centre of Birmingham than to local district hospitals.
Birmingham general hospital is friendly to its users, which goes against it. It is efficient in throughput per consultant firm, much better than the Queen Elizabeth hospital, and that also goes against it. It is not a mega-hospital, and that, too, goes against it. Until the blight brought about by the Government, that hospital had a better record of nurse retention after training than the Queen Elizabeth hospital, which also goes against it.
The operating theatres have been closed deliberately to force patients elsewhere so that the figures can be manipulated. It is known that accident and emergency cases go past the hospital to get to the general hospital. Because of the climate of fear, the position is so bad that Members of Parliament cannot be seen talking to senior staff in Birmingham general hospital by administrators simply because the staff fear for their careers and for those of their colleagues. Meetings have to take place elsewhere in the city.
That is just one example and we have heard many others in the debate. We have heard horrific stories about the waste of public money, going well beyond the bounds of public probity, especially in the speech by my hon. Friend the Member for Pontefract and Castleford (Mr. Lofthouse). However, I want to concentrate on community care, as the Secretary of State did not but I presume that the Minister will.
I want to draw the attention of the House to a survey published on 9 April which claimed that 80 per cent. of all those interviewed said that they had never heard of the policy of care in the community. Those who had heard of it said that they did not really know what its implications would be for them. The survey was Commissionered by the BBC education service for a new BBC 2 series, "Who Cares?"
The survey questioned a sample of 2,000 people mainly aged over 70 from England, Scotland and Wales and 80 per cent. said that they had never heard of the community care policy. Those were elderly people who were being cared for, or thought that they would need care in the future, as well as current and future carers of elderly people. They were living in a wide range of accommoda-tion—residential care, sheltered housing, both public and private, and in their own homes. By any stretch of the imagination, it was a good cross-section, but 80 per cent. said that they had never heard of the Government's policy of care in the community. More than 50 per cent. said that they needed more information about facilities and services. That issue is constantly raised throughout the country.
I give notice now of one question that I would like answered before the end of the debate and I shall repeat and come back to it during the course of my speech.
Frankly, I should have thought that it would have been answered by the Secretary of State. It is this: will the Government tell us the cost of their policy of care in the community? The Secretary of State did not talk about delaying the policy or putting it on ice. He talked about its slow implementation—that it is under way and will come to fruition. Therefore, he must have some idea about the cost of implementation.
Last July, a delay was announced to give people more time to get ready. I want to know what the Government have done with the extra time that they have had to calculate the cost of the implementation of that policy so that they can give that figure to the House for the first time.
The details of the survey which were supplied to me by the Carers National Association revealed a blunt message —80 per cent. said that the standard of care for elderly people should not depend upon individual income. If I may use a pun, there is a health warning in this survey for the Government, and that is that two thirds of carers had heard of the policy. Most did not have great expectations of it and three quarters of those said that a political party's policy on caring for elderly people was important when voting in a general election.
It has to be fair comment to say that it was nothing less than cruel for the Government to raise false hopes for an improvement of tailor-made services and support for the elderly and disabled and then to dash them last July during a statement from the Dispatch Box. This month should have seen the implementation of the policy.
The anger among carers, some at the end of their tether, is enormous. They soldiered on not knowing that they were carers, but they got the message that there was help on the way and right at the last minute their hopes were completely dashed and the help was withdrawn. The bitterness, anger, frustration, worry and concern has to be heard and seen to be believed. I wonder how many carers and groups Ministers have met, not in the great conference halls but on a one-to-one or a family basis since they announced that cruel decision last July.
Now there is considerable doubt about whether the Government's commitment to implementing their policy stands. I say "their" policy because it is certainly not the policy of the Griffiths report. The Government just chose the bits of that that they wanted.
We want to know why there is a delay in the implementation of the policy—why, in the Secretary of State's words, there is a slow implementation, and why, in the words of others, it has been abandoned. Last year, the then Secretary of State for Health said that it was because of the poll tax. He constantly repeated that on 18 July during his statement to the House. He referred to
excessive levels of community charge".
Later he said that it was
in the light of irresponsible behaviour by largely socialist local authorities, up and down the country, who cannot keep their policies within reasonable costs.
Then he said:
The policy was proceeding with a general welcome … until we reached the problem with the community charge." —[Official Report, 18 July 1990; Vol. 176, c. 1003–5.]
The general consensus at the time—not from the Government—was that it would cost about £15 per head per year on the community charge to implement the policy. Since then the Government have lopped £140 per head off the community charge. Even so, last July when the decision to abandon the policy was announced the community charge was expected to be here for ever more.
It would still affect and be affected by the implementation of the policy. What was to happen in 1992 and 1993 when the poll tax was still there? Indeed, it still will be there in one shape or another if the Government remain in office.
By now the Government must know the cost of implementing the policy and they should share that knowledge with the House and the nation. Two years, even allowing for the delay, is a short time in local government planning and expenditure. After plans have been made the Government cannot keep intervening and turning everything upside down like a constant revolution. There must be planning if policies are to be effectively implemented and we want to know what use the Government have made of the extra time. The Government constantly ask local authorities and the voluntary sector what they are doing with the extra time that they have been given to make sure that policies are up and running. They throw the question back to the Government.
Are Departments talking to one another? This crucial policy is shared by several Departments—Social Security, Health and Environment. It is a cliche to say that it is everybody's distant relative and nobody's baby, but it applies strongly in this case. Even the Department of Transport must be involved.
This morning I was in the constituency of Luton, South discussing with people in sheltered housing some of the problems that they encounter. Those people are in semi-care. They have their own front door and kitchen and a minimum amount of care outside their homes. They cannot even get bus services to do their shopping. They are being forced into dependency simply because of the Government's crazy policies. They said to me, "Our MP does not visit us very often. We do not know whether he uses a bus or whether he understands the situation."

Mr. Hayes: It is disgraceful for the hon. Gentleman to say that.

Mr. Rooker: It is not disgraceful. My job is to articulate the needs of the people of this country. If those needs are not articulated by Members of Parliament, somebody else has to voice them.
The Government must have made decisions about the transfer of the social security budget from income support to local authorities so that those authorities can assess the best means of operating the care plans and mixing public, private and voluntary care as required by the individual. Decisions must have been made about the transfer of mega-billions of public expenditure. [Interruption.] We are surely talking about well over a billion for a start.

Mr. Hayes: Will the hon. Gentleman give way?

Mr. Rooker: No, I will not give way.
That amount will rise to close on £2 billion this year —and that is purely for the income support for residential care. We also want to know the community care expenditure in respect of the health service because that will have to be transferred at some time. What is the mechanism for that and what are the Government's thoughts on it? They should share with the House, local authorities and care providers the decisions that they have taken.
It is still a matter of chance as to whether a person ends up in long-stay geriatric care, nursing care or residential care, all of which levy different costs and charges. The Minister of State and the Secretary of State know that that matter must be addressed. How are they addressing it? Secrecy should not be the order of the day. The providers are not Ministers but local people, the voluntary sector, local authorities and the private sector, and they need to know the Government's thinking. The Government have made no attempt to set out the key issues since the announcement of the abandonment of the policy.

Mr. Hayes: It is not an abandonment of policy.

Mr. Rooker: It is an abandonment of policy. Until Ministers tell us what they have been doing since they announced the decision in July about planning for the future and the costings for the policy, people will not believe they are serious about fully implementing the policy. Last year's figure for income support in terms of residential care was £1·3 billion, rising by about £400 million a year. That is in a narrow sector of care, and health service provision must be added. Therefore, we are talking about several billions. That issue caused the Government to Commissioner the Griffiths report in the first place. No decisions were being made about this continuing expenditure and there was an open-ended budget commitment on income support. That was why the Government listened to the Audit Commissioner in 1986 and asked for the Griffiths report.
There was a long delay before a White Paper was published in 1989. That was followed within days with the publication of the Bill, which was quickly pushed through to Royal Assent seven months later on 29 June 1990, with implementation this April. Less than three weeks later, the whole thing was put on ice. That is not good business or good management of Government affairs. We are entitled to be told about the consequences. I know that there was disquiet at the time about the rush to implementation —

Mr. Hayes: Where from?

Mr. Rooker: From the Select Committee.
Until 17 July, the Government were adamant that the Bill should be implemented on 1 April —

Mr. Hayes: rose—

Mr. Rooker: I am not giving way as there is no time to do so. I should be taking time out of the Minister's speech.
The Select Committee had misgivings about the timing. Others also had misgivings, but the Government had no misgivings. If those misgivings had any foundation, the Government should today tell us the real reason for the delay and the real costs of the implementation of the policy. Local government needs to know.
Last July, wild allegations were made about local government and the poll tax. That was the Government's reason for delaying the implementation of the Bill —

Mr. Hayes: rose—

Mr. Rooker: Sit down—I am not giving way.

Mr. Hayes: On a point of order, Mr. Deputy Speaker. Am I right in saying that it is for the Chair to tell me when to sit down and not the hon. Gentleman, who is afraid to answer questions.

Mr. Deputy Speaker: Order. The Chair is telling the hon. Gentleman to sit down. The Minister for Health will doubtless catch my eye in a few moments, and she can reflect the views of the hon. Gentleman and his hon. Friends.

Mr. Rooker: The main reason given for the abandonment of the policy was the poll tax, not that it could not be implemented by local authorities. The former Secretary of State said that the key reason was the cost on the poll tax, not the mechanics of implementation. If, in fact, it was not the poll tax that delayed implementation, what was it? Local government has not been treated fairly. We need to know the current figures.
The Secretary of State said last year that the delay was reasonable, and we think that the Government want to put off implementation until after the election. Of course, they think that they will not lose the election. The devastating critique—and the Minister has read it because she has answered questions on it—by the King's Fund Research Institute on the causes and consequences of the delay in implementing the community care programme have not been fully answered by the Government. There has not been an opportunity in the House either in an Adjournment debate or in an all-day debate. Today, the Minister has the opportunity to answer some of the points made in that important but not lengthy report. It contained all the bald points about the consequences of the Government's decision.
The obvious and major consequence is that by delaying implementation the resources will not be available for extending care at home. We must home in on that point because finance is the key to the policy and its implementation. Local authorties know that the resources are just not there. Health authorities have been busily shifting resource costs to the social security system. My hon. Friend the Member for Manchester, Withington (Mr. Bradley) gave an example of that. Money that would have been identified as directly possible for transfer to the care in the community programme is disappearing. It is no longer available because health authorities have gone their own way. They identified a window of opportunity to shift the burden on to the social security budget, which the Government are also short changing by not funding the full care costs.
It all comes back to money. Others are involved in juggling with the Government's budget, because it is an open-ended budget commitment. Surely the Government will not say that there is to be a continuing open-ended social security budget commitment over the next two years. That budget commitment would be growing by at least £400 million a year. The problem of implementation then will be twice as bad as it would have been had they done the job properly this year. They know that. They are storing up further problems. In the meantime, thousands of our fellow citizens are being deprived of the opportunity of remaining in their own homes, with the extra costs that that entails. Nobody claims that that is a cheap option, and I do not claim that the Government said that it was.
There is not enough time to do justice to the other issue that I intended to raise which has been touched upon by Conservative Members—mental illness, for which the Secretary of State highlighted the specific grant. I do not want to go into the details, but the difficulty is that the infrastructure to deal with the problem is not in place in the community. The grant will not cope with the problem,

because it will deal only with discharges, not with the people who will not be able to go into mental hospitals as they might once have done and later come out into the community. The whole policy is centred on discharges. When hospitals close, where is the procedure for making sure that their patients are picked up and helped into the care of the community in their own homes? There is no infrastructure. There is a moratorium on the care in the community policy—and that is putting it politely. There should be a similar moratorium on the closure of long-stay hospitals until the infrastructure for discharged patients in the community is put in place.

Mrs. Virginia Bottomley: That is exactly what we are doing.

Mr. Rooker: That is not what the Government are doing. If they were doing it we should not be able to see in large cities, and even in small cities, our fellow citizens wandering the streets, sleeping out at night with nowhere to live, because there is no proper effective system to take care of them. That is the difficulty that Ministers have brought upon themselves by continuing the discharge policy while abandoning the care in the community policy.
The Labour party, as you know, Mr. Deputy Speaker, is different from the Tories. I do not seek to drag you into the debate, but you know that, and so does Mr. Speaker. We shall offer a genuine partnership between Whitehall, town halls and the voluntary sector. We want authorities' social services spending on community care to be clearly identified, and the Government's contribution to be ring-fenced. The Government do not agree with that. That is why the money for community care is kept secret, and why we must press them on the costs. We will ring fence the money so that everybody knows exactly how much there is. We want a Department of Health and Community Care so that there can be no dithering about which Minister or Department is responsible for implementing policy. We shall restore fair choice as between public and private sector residential care, so that access to the massive public subsidy is on the same footing whether elderly and disabled people choose private residential care or a local authority or voluntary sector home.
We shall implement the remaining sections of the Disabled Persons (Services, Consultation and Representation) Act. We mean it when we say that users of the service have rights and we intend to see that those rights are given practical effect, which can be done only by implementing the rest of that Act. Our package will include support services for carers—the group the Government have forgotten. We shall provide care attendants to supply vital daytime and evening care, genuine and sufficient respite care to allow for breaks for carers, and a proper carers' benefit. Why should carers suffer massive financial loss as they do now? The Government are the Government and they will not tell us the cost of the policy that they are trying to implement. We will make sure that there is sanctuary provision for some of those transferred into the community who may need to be moved back to extra care temporarily due to stress. No one can deny that that problem exists.
I recently met a gentleman who is living in a nursing home in his own room on the ground floor with access to the garden after spending 41 years in a mental hospital being pumped full of drugs. We do not know why that happened. Having spent six months outside hospital, he is


transformed, but a whole lifetime has disappeared for one of our fellow citizens. It is not a party political matter, but there must be hundreds if not thousands of people to whom that has happened in the past. We must take that on board and make sure that the policy is not delayed any longer than necessary. It is why we object so much not about the implementation of the specific grant but to the abandonment of the policy.
It appears that the Government are seeking not to implement the policy but to let it wither on the vine, and to let local authorities pick up the tab. That will give the Government a further excuse to complain about local authorities.
We shall set about enabling all individuals, wherever they are and wherever their home has been for however many years, to achieve as full a life as possible within the community care programme. They should have—and their advocates should invoke for them all their rights to ensure that they get—justice and fair play. Disability should not equal dependency. The only way in which we should make sure that does not happen is by fully implementing the Government's plans plus what we would add to them as we do not see eye to eye with them on these matters.
I keep hearing sedentary interventions from Conservative Members about costs. When we are in government we shall fully disclose all the costs of our policy. We shall ring-fence funds so that we can be accountable. I am asking the Government to do the same for their policies. We want services to be formed and shaped not according to the purchasing power of users as consumers through the mechanism of the marketplace, but out of respect for them as human beings and their rights as our fellow citizens.

The Minister for Health (Mrs. Virginia Bottomley): I begin by joining others in congratulating the hon. Member for Neath (Mr. Hain) on his maiden speech. He follows in the footsteps of an hon. Member who was much respected in the House and is greatly Missed. It is clear from the hon. Gentleman's speech that he will be a champion of his constituents. Members of Parliament on both sides are united in their care and commitment to their constituents and the way in which they inform their judgments about policies in the House.
We have had a debate in which many hon. Members have spoken forcefully and with feeling. Frankly, I sympathise with the shadow health team. How difficult it must be to have to admit that, in respect of their portfolio, the Conservatives do it and have done it better. Take our record over the past decade. One has only to look at the potential in our reforms. We are committed to the best health service possible for patients. My hon. Friend the Member for Harlow (Mr. Hayes) is quite right. The Opposition argue for a proliferation of Commissioners and quangos. We do not. We rely on the dedicated work force of the national health service backed by a strong economy. That is why we can say, and the Opposition know, that the numbers of doctors, nurses, dentists and midwives have increased.
I am not surprised that Opposition Members groan; they realise only too well that when we talk about statistics, facts or incontrovertible information, they have

nothing in the cupboard. Their record has nothing except cuts and the destruction of the health service that my hon. Friend the Member for Hendon, South (Mr. Marshall) so clearly demonstrated.
During the previous 10 years, the numbers of in-patients, day cases and out-patients have all increased. Earlier today, my right hon. Friend the Secretary of State for Health announced the encouraging figures of the reduction in the number of people on waiting lists, especially the target group of those who have waited more than a year for treatment.
It is outrageous and deplorable for the hon. Member for Livingston (Mr. Cook) to compare the figures with those of the autumn of 1979, after the Labour Government had left office. My hon. Friends know that had he chosen to compare the figures to those of the spring of 1979, he would have found the highest figures for those on waiting lists.

Mr. Robin Cook: Let us do just that. If we compare the number of people on the waiting list in March 1979 with those announced at 3·30 pm this afternoon, we see that there are 144,000 more people on waiting lists now than there were in March 1979.

Mrs. Bottomley: indicated dissent.

Mr. Cook: The hon. Lady cannot deny it. I am citing figures from the press release issued by her Department this afternoon. If she wishes to quote figures for nurses, she should read the parliamentary answers that she signs. She would then know, from an answer that she gave to me, that in five years the previous Labour Government created twice as many nurses as this Government have done in 10 years and at four times the rate.

Mrs. Bottomley: There is not one nurse in the country who does not know perfectly well that nurses' pay has increased by more than 40 per cent. under this Government, whereas it fell by more than 20 per cent. under the previous Labour Government. In fact, only recently the Royal College of Nursing said that the main problem is not nurses' pay but their status. We recognise that, which is why nurses appreciate the practical steps taken by my right hon. Friend the Secretary of State to enhance the role of nurses, to introduce Project 2000 and to ensure that nurses are properly recognised as full members of the health care team.
Nurses can be confident under this Government. The Opposition make promises but constantly fail to deliver. We have invested in the health service and increased the number of nurses and doctors. We have provided £32 billion this year which has been highlighted by so many of my hon. Friends. People are living longer—there is an extra two years of life expectancy—and infant mortality continues to fall; about half the previous number of women now die in childbirth and fewer men under the age of 65 die of strokes and heart disease.
When did the Labour party suddenly begin to think that perhaps the NHS needed restructuring? It was only after our reforms started to capture the imagination of the people who work in the NHS. We see the enthusiasm and commitment of an increasing number of people who recognise the opportunities that are made available by our reforms to improve patient care and to make more responsive plans to meet their patients' needs. One thousand seven hundred GPs have chosen to become fund


holders and there are 57 trusts now operating. There are more than 100 units queuing up to be part of the second wave.
Labour's opposition to fund holders is now perhaps a little less shrill. It will not be long before the noise about trusts also abates. Perhaps by the time they revise their policy they will adopt trusts as they have adopted the right to buy, trade union reform and multilateral disarmament. I am afraid that my hon. Friends have seen and heard it all before.
The hon. Member for Livingston fails to understand the growing support for the reforms among those who work in the NHS. Labour had to resort to threatening trust managers with their jobs to try to dampen their enthusiasm, which was disgraceful. Thankfully, Labour has stopped short of threatening GP fund holders with their jobs. It would have to face committed family doctors. Labour is playing the part of the health service Rot tweiler but without the teeth. Labour's leader—rightly—will not let his Front Bench off the leash yet. The shadow Health Secretary has been muzzled by his own leader and he and his colleagues have been forbidden to make pledges of increased funding to the health service. They can only stand on the sidelines and shout as we deliver the increased resources—£32 billion this year—[Interruption.] I am grateful to have had the opportunity to give that information.
Labour's approach is based on promises, on a scandalous disregard for the achievements of the NHS and social service staff, on Sunday surveys for Monday publicity and on sackloads of words. People in the health service and welfare services know that we are a Government with a record to be proud of who have a great deal more to do. We live in times of change and times of improvement. There is a great deal happening in the health service that we feel strongly about.
I agree that it is easy in a debate to concentrate on the exciting developments in the health service and the new treatments available, such as hip replacements and cataract treatments—treatments that push forward the frontiers of science and were not available before. Like other hon. Members, I wish to concentrate on community care aspects. Ninety-five per cent. of health care takes place in the community. Our policies for implementing community care are extremely important. Community care is vital to the nation as a whole. It potentially affects all of us as givers or receivers of care. Again, our valuable record demonstrates our commitment to enabling more vulnerable people to enjoy as full a life as possible in the community.
Spending on personal social services has increased by 53 per cent. in real terms. Labour's Sunday surveys do not seem to care for that progress. This year's standard spending figure for personal social services is £4·5 billion —a cash increase of more than 23·5 per cent. on last year and the biggest increase for 15 years in social service spending. I am afraid that Labour social service speakers are silent on that spending. Cash benefits for the disabled and the long-term sick rose from £1·8 billion in 1978–79 to £8·3 billion in 1989–90. The number of those receiving invalid care allowance rose spectacularly from 11,000 to 130,000 in just five years. That means more help for carers and for those cared for.
I hope that the issues of mental handicap and mental illness unite hon. Members. There has been a threefold increase in the number of community psychiatric nurses.
They are the key agents for effective care of the mentally ill in the community. There has been a sixfold increase in the number of mental handicap nurses. Those substantial achievements ensure that community care can be implemented successfully and effectively.
I am staggered to hear hon. Members who should know better talk about care in the community being abandoned. I suggest that each of them makes contact with his or her director of social services. I suggest that the hon. Member for Birmingham, Perry Barr (Mr. Rooker) talks to his director of social services. I met her on Tuesday this week. She has been at the forefront in implementing community care and recognising the role of carers. Like other directors of social service departments, she has seen the amount that we believe social services should spend increased by a record 23·5 per cent. this year.

Mr. Hayes: Will my hon. Friend remind the hon. Member for Birmingham, Perry Barr (Mr. Rooker) that the Social Services Select Committee warned the Government of the dangers of speeding implementation of community care?

Mrs. Bottomley: I thank my hon. Friend. One could, in justice, say that the hon. Member for Perry Barr made that point himself. There were many conflicting themes in his speech. He questioned whether anyone knew about community care and said that the carers were upset that it had not taken place. He asked why we had not gone ahead but also said that the Social Services Committee had said that we were going too fast.
I wish to talk about the aims and goals of the policy. People should enjoy the optimum quality of life and maximum independence for as long as they can. Service users should have as much say as possible in the care provided for them. Carers should be properly supported. The policy is about promoting choice and promoting dignity. It is about catering for people's needs, not providing services according to those that are available.
I wish to refer to many of the themes that were raised during the debate.
My hon. Friend the Member for Cheadle (Mr. Day) spoke forcefully and effectively about the reforms and the need for change. It is a question not simply of throwing more money at the health service but of ensuring that that money is used well. My hon. Friend the Member for Harlow also made a foreceful and clear speech and referred to that eminent academic, Professor Le Grand, and his view, which I am pleased that he drew to the attention of the House. He also identified the important work done by the Audit Commissioner to ensure, in the words of my right hon. Friend the Member for Finchley (Mrs. Thatcher), that efficiency is the ally and not the enemy of compassion. By achieving value for money we can ensure that we improve our services to the best possible effect.
My hon. Friend the Member for Bury, North (Mr. Burt), in an excellent speech, identified in practical terms the changes that have taken place in his health authority —the increases in funding, in professional staff and in care for patients. My hon. Friend the Member for Wyre Forest (Mr. Coombs) spoke about the changes, improvements and opportunities. We shall consider carefully his call for a further extension of fundholders to enable those with smaller practices to come within the scheme.
My hon. Friend the Member for Hendon, South made it only too clear that we should judge records as opposed to rhetoric when we decide which party can best be trusted with the health service. We all agree with the remarks made by my hon. Friend the Member for Bolton, North-East (Mr. Thurnham). He said that the longest waiting time in the national health service is the wait for Labour's policy. That is only too right. He raised an important issue about inter-country adoption and I shall carry it forward. I value the work that he has done to ensure that inter-country adoption, which plays an important part for many families, is properly controlled, the families are properly scrutinised and assessed, and the local authorities co-operate and undertake their work effectively. I also value his assistance in ensuring that we have an effective policy in that area.
However, the hon. Member for Manchester, Withington (Mr. Bradley) gave a biased account and a catalogue of complaints about his constituency. That is something that those in the health service find so desperately demoralising about having a Labour Member of Parliament. Unlike my hon. Friends, who look for progress, success and achievement in the health service, Labour Members go around looking for ways in which they can denigrate the achievements of those who dedicate their lives to providing health care. I feel that I owe it to those who work in the health service in the constituency of the hon. Member for Withington to point out—he is obviously not going to do so—that the number of day cases that they treated between 1982 and 1990 rose by 72·3 per cent. and the number of in-patients rose by over 10 per cent. Moreover, my hon. Friend the Parliamentary Under-Secretary, who is to meet the hon. Gentleman about some of the proposals for change in his area, recently opened a community health centre at the cost of £1·2 million. A £4·2 million development—

Mr. Bradley: Will the Minister give way?

Mrs. Bottomley: I am sorry, but I shall not give way. I feel that the work of the health service in Manchester will not be recognised if I do not put the record straight, and I shall not allow the hon. Gentleman to contaminate its excellent work again.
The new hon. Member for Neath made an excellent speech. However, I do not want him to follow in the footsteps of some of his colleagues, because there was a tendency to follow the same path. In his maiden speech he overlooked the fact that, between 1979 and 1988, the number of in-patients rose by 37 per cent., the number of out-patients rose by 37 per cent. and the number of day cases that were treated trebled in his part of the world. As a new Member, he will want the health workers in his constituency to recognise the great developments that have taken place.
My hon. Friend the Member for Kensington (Mr. Fishburn) has provided a most valuable service to the House in identifying and pushing forward the cause of nurse prescribing. We are making good headway on that issue and, as he knows, a cost-benefit analysis is under way, the results of which we hope to have by August. The Government have made it clear that, like my hon. Friend,

they believe that there is more that nurses can do. They will be vital when we fully implement community care. We want to use their professional skills to the full.
I am also grateful to my hon. Friend the Member for Kensington for mentioning women doctors. They have made excellent progress. About one in eight GPs used to be women; by 1989, the figure was one in five; and this year —I hope that hon. Members will bear with me, hon. Ladies certainly will—one in four GPs will be women.
My hon. Friend also raised important points about encouraging more people from ethnic communities to come forward to train as doctors. I shall certainly follow that up.
My hon. Friend the Member for Bournemouth, West (Mr. Butterfill), who has done so much to promote the cause of community care, identified a number of important issues. We value the steps that he is taking in relation to small residential homes. He mentioned the new drug for those with Alzheimer's disease. There are some exciting developments and I can assure my hon. Friend that the drug, which is currently under trial, will, we hope, come forward for licensing. But, of course, the strict tests for licensing must include safety, quality and efficacy. There is no doubt that many people who suffer from Alzheimer's disease in this country will greatly benefit if the drug can receive a full licence.
A number of other points were raised. The hon. Member for Pontefract and Castleford (Mr. Lofthouse) spoke of consultants in his health authority visiting the United States to try to inform themselves on how to carry forward their work in the health service. I shall certainly look into that aspect, but if my investigation reveals that those consultants and managers were trying to ensure that their work was informed by best management practice, by the effective use of resources, all of us should applaud that. Of course, it is not the case that our health service, available to all and free at the point of delivery, is anything other than profoundly different in many aspects from the provision of health care in the United States.
The hon. Gentleman also mentioned the issue of the security of those working in the health service—a subject which we are addressing more carefully.
Many hon. Members have questioned the work under way to implement community care. This April, local authorities were required to have in place complaints procedures and inspection units. Increased training resources have been made available so that 140,000 staff in social service departments are this year being trained for care in the community. We have carried forward our drug and alcohol assistance for the voluntary organisations. Above all, the work done by my hon. Friend the Parliamentary Under-Secretary to ensure that the work on mental illness makes further progress is extremely important. Hon. Members have been united in their concern to ensure that the mentally ill receive the services that they require. That is why the specific grant, backed by capital assistance, was introduced to ensure that those leaving a psychiatric hospital or those in need of care in the community receive the help required.

Mr. Tom Clarke: Will the Minister of State give way?

Mrs. Bottomley: I think that the hon. Gentleman would like me to address the issue of the Disabled Persons


(Services, Consultation and Representation) Act 1986. He has done as much as any hon. Member to identify the needs of the disabled. The key point is that the care in the community proposals overtake the 1986 Act and ensure the user is at the forefront of the assessment. The lion's share of the Act has already been implemented, but I shall repeat the assurance that I have already given. Should the need emerge for further elements of the Act to be implemented, we shall most certainly continue to consider that.

Mr. Clarke: On a point of order, Mr. Speaker.

Mr. Speaker: I have heard nothing out of order.

Mr. Clarke: Is it in order, Mr. Speaker, for the Minister to mislead the House by saying that the lion's share —

Mr. Speaker: Order. The Minister is not misleading the House.

Mrs. Bottomley: When he reads the record, I think that the hon. Gentleman will find that I have covered his points fairly and squarely. I should, of course, be happy to discuss the matter further with him.
May I ask the hon. Member for Perry Barr to spend a long time with his own director of social services and to continue to work with us to promote partnerships throughout the country? He mentioned regional health authorities —

Mr. Derek Foster: rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—

The House divided: Ayes 221, Noes 310.

Division No. 118]
[10 pm


AYES


Abbott, Ms Diane
Bray, Dr Jeremy


Adams, Mrs Irene (Paisley, N.)
Brown, Nicholas (Newcastle E)


Allen, Graham
Brown, Ron (Edinburgh Leith)


Alton, David
Bruce, Malcolm (Gordon)


Archer, Rt Hon Peter
Buckley, George J.


Ashley, Rt Hon Jack
Caborn, Richard


Ashton, Joe
Callaghan, Jim


Banks, Tony (Newham NW)
Campbell, Menzies (Fife NE)


Barnes, Harry (Derbyshire NE)
Campbell, Ron (Blyth Valley)


Barnes, Mrs Rosie (Greenwich)
Campbell-Savours, D. N.


Barron, Kevin
Carr, Michael


Battle, John
Cartwright, John


Beckett, Margaret
Clark, Dr David (S Shields)


Beith, A. J.
Clarke, Tom (Monklands W)


Bellotti, David
Clelland, David


Benn, Rt Hon Tony
Clwyd, Mrs Ann


Bennett, A. F. (D'nt'n &amp; R'dish)
Cohen, Harry


Benton, Joseph
Cook, Robin (Livingston)


Bermingham, Gerald
Corbett, Robin


Bidwell, Sydney
Corbyn, Jeremy


Blair, Tony
Cousins, Jim


Blunkett, David
Crowther, Stan


Boateng, Paul
Cryer, Bob


Boyes, Roland
Cummings, John


Bradley, Keith
Cunliffe, Lawrence





Cunningham, Dr John
Macdonald, Calum A.


Dalyell, Tam
McGrady, Eddie


Darling, Alistair
McKelvey, William


Davies, Rt Hon Denzil (Llanelli)
McLeish, Henry


Davies, Ron (Caerphilly)
Maclennan, Robert


Davis, Terry (B'ham Hodge H'I)
McMaster, Gordon


Dewar, Donald
McNamara, Kevin


Dixon, Don
McWilliam, John


Dobson, Frank
Madden, Max


Douglas, Dick
Mahon, Mrs Alice


Duffy, A. E. P.
Marek, Dr John


Dunnachie, Jimmy
Marshall, David (Shettleston)


Dunwoody, Hon Mrs Gwyneth
Marshall, Jim (Leicester S)


Eadie, Alexander
Martin, Michael J. (Springburn)


Evans, John (St Helens N)
Martlew, Eric


Ewing, Mrs Margaret (Moray)
Maxton, John


Fearn, Ronald
Meacher, Michael


Field, Frank (Birkenhead)
Meale, Alan


Fisher, Mark
Michael, Alun


Flannery, Martin
Michie, Mrs Ray (Arg'l &amp; Bute)


Flynn, Paul
Mitchell, Austin (G't Grimsby)


Foot, Rt Hon Michael
Moonie, Dr Lewis


Foster, Derek
Morgan, Rhodri


Foulkes, George
Morley, Elliot


Fraser, John
Morris, Rt Hon A. (W'shawe)


Fyfe, Maria
Morris, Rt Hon J. (Aberavon)


Galbraith, Sam
Mowlam, Marjorie


Galloway, George
Mullin, Chris


Garrett, John (Norwich South)
Murphy, Paul


Garrett, Ted (Wallsend)
Nellist, Dave


George, Bruce
Oakes, Rt Hon Gordon


Godman, Dr Norman A.
O'Brien, William


Golding, Mrs Llin
O'Hara, Edward


Gordon, Mildred
O'Neill, Martin


Gould, Bryan
Orme, Rt Hon Stanley


Graham, Thomas
Owen, Rt Hon Dr David


Grant, Bernie (Tottenham)
Parry, Robert


Griffiths, Nigel (Edinburgh S)
Patchett, Terry


Griffiths, Win (Bridgend)
Pendry, Tom


Grocott, Bruce
Pike, Peter L.


Hain, Peter
Powell, Ray (Ogmore)


Hardy, Peter
Prescott, John


Harman, Ms Harriet
Primarolo, Dawn


Hattersley, Rt Hon Roy
Quin, Ms Joyce


Haynes, Frank
Radice, Giles


Healey, Rt Hon Denis
Randall, Stuart


Henderson, Doug
Redmond, Martin


Hinchliffe, David
Rees, Rt Hon Merlyn


Hoey, Ms Kate (Vauxhall)
Reid, Dr John


Hogg, N. (C'nauld &amp; Kilsyth)
Richardson, Jo


Home Robertson, John
Robertson, George


Howarth, George (Knowsley N)
Robinson, Geoffrey


Howells, Geraint
Rogers, Allan


Howells, Dr. Kim (Pontypridd)
Rooker, Jeff


Hughes, John (Coventry NE)
Rooney, Terence


Hughes, Roy (Newport E)
Ross, Ernie (Dundee W)


Hughes, Simon (Southwark)
Rowlands, Ted


Illsley, Eric
Ruddock, Joan


Ingram, Adam
Salmond, Alex


Janner, Greville
Sedgemore, Brian


Jones, Barry (Alyn &amp; Deeslde)
Sheerman, Barry


Jones, Ieuan (Ynys Môn)
Sheldon, Rt Hon Robert


Jones, Martyn (Clwyd S W)
Shore, Rt Hon Peter


Kaufman, Rt Hon Gerald
Short, Clare


Kennedy, Charles
Skinner, Dennis


Kilfedder, James
Smith, Andrew (Oxford E)


Kinnock, Rt Hon Neil
Smith, C. (Isl'ton &amp; F'bury)


Kirkwood, Archy
Smith, Rt Hon J. (Monk'ds E)


Lambie, David
Smith, J. P. (Vale of Glam)


Lamond, James
Snape, Peter


Leadbitter, Ted
Soley, Clive


Leighton, Ron
Spearing, Nigel


Lestor, Joan (Eccles)
Stott, Roger


Lewis, Terry
Strang, Gavin


Livingstone, Ken
Straw, Jack


Livsey, Richard
Taylor, Mrs Ann (Dewsbury)


Lloyd, Tony (Stretford)
Taylor, Matthew (Truro)


Lofthouse, Geoffrey
Thompson, Jack (Wansbeck)


Loyden, Eddie
Wallace, James


McAvoy, Thomas
Walley, Joan






Warded, Gareth (Gower)
Worthington, Tony


Wareing, Robert N.
Wray, Jimmy


Watson, Mike (Glasgow, C)
Young, David (Bolton SE)


Welsh, Andrew (Angus E)



Welsh, Michael (Doncaster N)
Tellers for the Ayes:


Williams, Rt Hon Alan
Mr. Ken Eastham and


Williams, Alan W. (Carm'then)
Mr. Allen McKay.


Winnick, David





NOES


Adley, Robert
Couchman, James


Aitken, Jonathan
Cran, James


Alexander, Richard
Currie, Mrs Edwina


Alison, Rt Hon Michael
Davies, Q. (Stamf'd &amp; Spald'g)


Allason, Rupert
Davis, David (Boothferry)


Amery, Rt Hon Julian
Day, Stephen


Amess, David
Devlin, Tim


Amos, Alan
Dickens, Geoffrey


Arbuthnot, James
Dicks, Terry


Arnold, Jacques (Gravesham)
Dorrell, Stephen


Arnold, Sir Thomas
Douglas-Hamilton, Lord James


Ashby, David
Dover, Den


Aspinwall, Jack
Dunn, Bob


Atkinson, David
Durant, Sir Anthony


Baker, Rt Hon K. (Mole Valley)
Eggar, Tim


Baker, Nicholas (Dorset N)
Emery, Sir Peter


Baldry, Tony
Evans, David (Welwyn Hatf'd)


Banks, Robert (Harrogate)
Fairbairn, Sir Nicholas


Batiste, Spencer
Fallon, Michael


Beaumont-Dark, Anthony
Fenner, Dame Peggy


Bellingham, Henry
Field, Barry (Isle of Wight)


Bendall, Vivian
Finsberg, Sir Geoffrey


Bennett, Nicholas (Pembroke)
Fishburn, John Dudley


Benyon, W.
Fookes, Dame Janet


Bevan, David Gilroy
Forman, Nigel


Bitten, Rt Hon John
Forsyth, Michael (Stirling)


Blackburn, Dr John G.
Fowler, Rt Hon Sir Norman


Blaker, Rt Hon Sir Peter
Fox, Sir Marcus


Body, Sir Richard
Franks, Cecil


Bonsor, Sir Nicholas
Freeman, Roger


Boscawen, Hon Robert
French, Douglas


Boswell, Tim
Fry, Peter


Bottom ley, Peter
Gale, Roger


Bottomley, Mrs Virginia
Gill, Christopher


Bowden, Gerald (Dulwich)
Glyn, Dr Sir Alan


Bowis, John
Goodhart, Sir Philip


Boyson, Rt Hon Dr Sir Rhodes
Goodlad, Alastair


Braine, Rt Hon Sir Bernard
Goodson-Wickes, Dr Charles


Brazier, Julian
Gorman, Mrs Teresa


Bright, Graham
Gorst, John


Brown, Michael (Brigg &amp; Cl't's)
Grant, Sir Anthony (CambsSW)


Bruce, Ian (Dorset South)
Greenway, Harry (Ealing N)


Buchanan-Smith, Rt Hon Alick
Greenway, John (Ryedale)


Buck, Sir Antony
Gregory, Conal


Budgen, Nicholas
Griffiths, Peter (Portsmouth N)


Burns, Simon
Grist, Ian


Burt, Alistair
Ground, Patrick


Butler, Chris
Grylls, Michael


Butterfill, John
Hague, William


Carlisle, John, (Luton N)
Hamilton, Hon Archie (Epsom)


Carlisle, Kenneth (Lincoln)
Hamilton, Neil (Tatton)


Carrington, Matthew
Hampson, Dr Keith


Carttiss, Michael
Hanley, Jeremy


Cash, William
Hannam, John


Chalker, Rt Hon Mrs Lynda
Hargreaves, A. (B'ham H'll Gr')


Channon, Rt Hon Paul
Hargreaves, Ken (Hyndburn)


Chapman, Sydney
Harris, David


Chope, Christopher
Haselhurst, Alan


Churchill, Mr
Hawkins, Christopher


Clark, Rt Hon Alan (Plymouth)
Hayes, Jerry


Clark, Dr Michael (Rochford)
Hayhoe, Rt Hon Sir Barney


Clark, Rt Hon Sir William
Hayward, Robert


Clarke, Rt Hon K. (Rushcliffe)
Heseltine, Rt Hon Michael


Colvin, Michael
Hicks, Mrs Maureen (Wolv NE)


Conway, Derek
Hicks, Robert (Cornwall SE)


Coombs, Anthony (Wyre F'rest)
Higgins, Rt Hon Terence L.


Coombs, Simon (Swindon)
Hill, James


Cope, Rt Hon John
Hind, Kenneth


Cormack, Patrick
Hogg, Hon Douglas (Gr'th'm)





Holt, Richard
Norris, Steve


Hordern, Sir Peter
Onslow, Rt Hon Cranley


Howard, Rt Hon Michael
Oppenheim, Phillip


Howarth, Alan (Strat'd-on-A)
Page, Richard


Howarth, G. (Cannock &amp; B'wd)
Paice, James


Howe, Rt Hon Sir Geoffrey
Parkinson, Rt Hon Cecil


Howell, Ralph (North Norfolk)
Patnick, Irvine


Hughes, Robert G. (Harrow W)
Patten, Rt Hon Chris (Bath)


Hunt, Sir John (Ravensbourne)
Patten, Rt Hon John


Hunter, Andrew
Pattie, Rt Hon Sir Geoffrey


Irvine, Michael
Peacock, Mrs Elizabeth


Irving, Sir Charles
Porter, David (Waveney)


Jack, Michael
Portillo, Michael


Janman, Tim
Powell, William (Corby)


Jessel, Toby
Price, Sir David


Johnson Smith, Sir Geoffrey
Raison, Rt Hon Sir Timothy


Jones, Gwilym (Cardiff N)
Rhodes James, Robert


Jones, Robert B (Herts W)
Riddick, Graham


Jopling, Rt Hon Michael
Ridley, Rt Hon Nicholas


Kellett-Bowman, Dame Elaine
Rifkind, Rt Hon Malcolm


Key, Robert
Roberts, Sir Wyn (Conwy)


King, Roger (B'ham N'thfield)
Roe, Mrs Marion


King, Rt Hon Tom (Bridgwater)
Rossi, Sir Hugh


Kirkhope, Timothy
Rost, Peter


Knapman, Roger
Rumbold, Rt Hon Mrs Angela


Knight, Greg (Derby North)
Ryder, Rt Hon Richard


Knight, Dame Jill (Edgbaston)
Sainsbury, Hon Tim


Knox, David
Sayeed, Jonathan


Lamont, Rt Hon Norman
Scott, Rt Hon Nicholas


Lang, Rt Hon Ian
Shaw, David (Dover)


Latham, Michael
Shaw, Sir Giles (Pudsey)


Lawrence, Ivan
Shaw, Sir Michael (Scarb')


Lawson, Rt Hon Nigel
Shelton, Sir William


Lennox-Boyd, Hon Mark
Shephard, Mrs G. (Norfolk SW)


Lester, Jim (Broxtowe)
Shepherd, Colin (Hereford)


Lilley, Rt Hon Peter
Shepherd, Richard (Aldridge)


Lloyd, Sir Ian (Havant)
Shersby, Michael


Lloyd, Peter (Fareham)
Sims, Roger


Lord, Michael
Skeet, Sir Trevor


Luce, Rt Hon Sir Richard
Smith, Tim (Beaconsfield)


Lyell, Rt Hon Sir Nicholas
Speed, Keith


McCrindle, Sir Robert
Speller, Tony


Macfarlane, Sir Neil
Spicer, Sir Jim (Dorset W)


MacGregor, Rt Hon John
Spicer, Michael (S Worcs)


MacKay, Andrew (E Berkshire)
Squire, Robin


Maclean, David
Stanbrook, Ivor


McNair-Wilson, Sir Patrick
Stanley, Rt Hon Sir John


Major, Rt Hon John
Steen, Anthony


Malins, Humfrey
Stern, Michael


Mans, Keith
Stevens, Lewis


Maples, John
Stewart, Allan (Eastwood,)


Marland, Paul
Stewart, Andy (Sherwood)


Marlow, Tony
Stewart, Rt Hon Ian (Herts N)


Marshall, John (Hendon S)
Stokes, Sir John


Marshall, Sir Michael (Arundel)
Sumberg, David


Martin, David (Portsmouth S)
Summerson, Hugo


Mates, Michael
Tapsell, Sir Peter


Mawhinney, Dr Brian
Taylor, Ian (Esher)


Maxwell-Hyslop, Robin
Taylor, Teddy (S'end E)


Mayhew, Rt Hon Sir Patrick
Tebbit, Rt Hon Norman


Meyer, Sir Anthony
Thompson, D. (Calder Valley)


Miller, Sir Hal
Thorne, Neil


Mills, Iain
Thurnham, Peter


Miscampbell, Norman
Townend, John (Bridlington)


Mitchell, Andrew (Gedling)
Townsend, Cyril D. (B'heath)


Mitchell, Sir David
Tracey, Richard


Moate, Roger
Tredinnick, David


Monro, Sir Hector
Trippier, David


Montgomery, Sir Fergus
Twinn, Dr Ian


Moore, Rt Hon John
Vaughan, Sir Gerard


Morrison, Sir Charles
Viggers, Peter


Morrison, Rt Hon Sir Peter
Waldegrave, Rt Hon William


Moss, Malcolm
Walden, George


Mudd, David
Walker, Bill (T'side North)


Neale, Sir Gerrard
Walker, Rt Hon P. (W'cester)


Nelson, Anthony
Walters, Sir Dennis


Neubert, Sir Michael
Ward, John


Nicholls, Patrick
Warren, Kenneth


Nicholson, David (Taunton)
Watts, John


Nicholson, Emma (Devon West)
Wells, Bowen






Whitney, Ray
Woodcock, Dr. Mike


Wiggin, Jerry
Yeo, Tim


Wilkinson, John
Young, Sir George (Acton)


Wilshire, David
Younger, Rt Hon George


Winterton, Mrs Ann



Winterton, Nicholas
Tellers for tbe Noes:


Wolfson, Mark
Mr. David Lightbown and


Wood, Timothy
Mr. John M. Taylor.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. DEPUTY SPEAKER: forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House congratulates the Government on the near 25 per cent. increase in the number of in-patients treated and the near 100 per cent. increase in the number of hospital day cases since 1979 and on the further recent fall in hospital waiting times; welcomes the successful introduction of the Government's reforms which are already leading to better quality services, more responsiveness to people's needs and wishes and improved value for money; notes that the reforms are being backed in 1991–92 by record increases in resources for the National Health Service and in the standard spending assessment for the personal social services; welcomes the Government's commitment to full implementation of its community care policy, through local government, by April 1993; supports the Government's objective of using the National Health Service reforms to deliver real improvements in the health of the people through the development of a national health strategy; and looks forward to the forthcoming publication of a consultative document setting out the Government's proposals.

Community Charge

Mr. Speaker: We now come to the two community charge prayers—

Mr. A. J. Beith: On a point of order, Mr. Speaker. There is a correction slip for the regulations, SI 230, which has been made available to the House. Would it be possible to clarify the contents of that correction slip, because, at first sight, the matter to be corrected and the correction appear to be identical, unless the semi-colon at the end of the correction is integral to it rather than separating it from the other mistake in the orginal regulations. How can that obscure point be clarified so that we know what we are talking about?

Mr. Speaker: Would it be for the convenience of the House if I read out the correct version?

Mr. Beith: That would be extremely helpful.

Mr. Speaker: It says:
"regulation 9(3):
delete'2 x C-(W x £104)/1+ F'
substitute'2 x C-(W +£104)"/1+ F'
I hope that that is clear.

Mr. Brian Gould: I beg to move,
That the Personal Community Charge (Reductions) (England) Regulations 1991 (S.I., 1991, No. 230), a copy of which was laid before this House on 14th February, be revoked.
If I felt generous, I might spin my speech out long enough to allow the Minister to receive advice from his civil servants on how to respond to the point of order raised. Whether or not he can respond to that point of order and clarify this matter, it is symptomatic of yet another piece of confusion in what has become the whole long and sorry saga of the poll tax. In a few minutes, the Minister will have, not for the first time, the embarrassing task of defending one further instalment in that saga. As we know, the poll tax saga is set, unlike its main progenitor, to go on and on and on.
We are told that the Cabinet will reach a decision tomorrow—a decision that we all know is just as unlikely to put an end to the poll tax and the continuing controversy it has created as all those other decisions, reviews, sweeteners and transitional relief schemes that we have been assured at regular intervals will finally do the trick.
The Minister's embarrassment is all too well founded. Even if we limit ourselves to the narrow category of transitional relief schemes, tonight's debate deals with what, on any reckoning, must be regarded as both the third and the fourth versions of such a scheme. There are the third and fourth attempts to—

Mr. Jacques Arnold: rose—

Mr. Gould: I shall not give way; I have just started.
This is the third and fourth attempt to put in place a scheme that will work. Even in the limited terms that have been claimed for it and its predecessors, we have had, first, the initial transitional relief scheme which was forced upon a reluctant Government. We then had the modified version

of that initial scheme produced by the right hon. Member for Bath (Mr. Patten). The whole thing then began to speed up. Then came the present Secretary of State's new scheme, announced at the beginning of this year, and, in even quicker order, the new replacement and refinement of that scheme which the right hon. Gentleman announced a week or two ago.
It is little wonder that the Minister of State has at times been so bemused by that bewildering sequence of events. He and his Secretary of State have alternated in producing figures which have bounced up and down as far and as fast as a yo-yo.

Mr. Arnold: Will the hon. Gentleman give way?

Mr. Gould: No, I am just about to embarrass the Minister of State. When I have done so, I shall give way to the hon. Gentleman.
On 25 March, the Minister told us that the new version of the scheme would benefit 8 million people. Perhaps, to be fair, he is not at his best at this time of the night. Less than 48 hours later, the Secretary of State had to correct him by pointing out that he was wrong to the tune of a little matter of 100 per cent. Little wonder that Ministers have made such a mess of the poll tax if they have such difficulty in agreeing among themselves or even understanding their own figures. I expect, but I may be wrong, that the Minister will tonight adhere to the 16 million figure given by the Secretary of State, but why should we believe him on this occasion when he has proved to be so wrong before?

Mr. Arnold: What would the hon. Gentleman say to the 9,400 community charge payers in Gravesham who would lose by his abolition of the community charge reduction scheme? Furthermore, what would he say to the 71,000 community charge payers in Gravesham who would lose £12 per head under his own fair rates criteria?

Mr. Gould: I am delighted to say that, even in Gravesham, there would be substantial savings in administrative costs and collection levels, and that many poll tax payers would be relieved of that unfair burden.
Similar confusion attends other questions, such as the public spending cost of this measure and the extent to which the money set aside for the purpose will be offset by savings on the amounts spent on the rebate scheme. It has to be said that the Government have moved, albeit painfully slowly.
The present scheme's predecessors were fatally flawed, because they dealt in assumed rather than real figures and because such large categories of people were excluded from the benefits of the scheme. When we mentioned those matters and made justified criticisms, the Government denied that the schemes were flawed in those ways; but they have now conceded, at least implicitly, that the force of our criticisms was great. Such is the power of effective opposition. That is why this revised scheme has been brought forward—because we have prevailed in our insistence that its predecessors were so deficient In what they sought to do.
However, the Secretary of State remains wrong, in what is now a long and dishonourable tradition in such mattters, when he asserts in a cavalier fashion that no one will pay more under this scheme than the £1 per week above their old rates bill that it specifies.
Will the Minister of State confirm that significant categories of people remain excluded from the scheme? Will he confirm that among those excluded will be people who move during the current year since 31 March, young adults who became 18 during the year and people who live in properties on which rates were not payable before the poll tax was introduced—for example, properties built since that date? The real peculiarity of the scheme is not confusion over the numbers affected, over the costs of the scheme or indeed over the catetories which are within or outside it. The real peculiarity lies in the concept of the scheme.
What is the great and central virtue claimed for the scheme? It is instructive to try to answer that question, because the answer is that the great central virtue is the extent to which the scheme is able to reduce bills so that they approximate to the levels of the bills sent out under the much derided rates. That is what is claimed for it.
What is the benchmark by which that great virtue is to be measured? Why, it is the old rates bill itself which is said to embody that great benefit; that very Nirvana to which the scheme can do no more than approximate.
I fully accept that the old rates bill is the embodiment of that virtue. I welcome the extent to which poll tax bills will be brought to approximate to the old rates bills. But if that is the rationale of the scheme, why fiddle around with all the confusion and all the costs of maintaining the poll tax? Why bother with all the horrendous headaches of administrative costs, the register, the low collection levels, the sweeteners and the transitional relief schemes themselves? Why not show a little courage and honesty?
Why not be honest and straightforward and admit that, rather than aspire merely to approximate to rates bills, it would be better to go directly to the rates bills themselves? Why not use the money available under the scheme, as we have proposed, to institute a proper fair rates scheme? Why not end the shilly-shallying and accept the logic of the scheme—the logic which points inexorably away from the poll tax and towards an immediate return to the rates?

Sir Jim Spicer: I am rather puzzled because it is within my recollection that, at the time of the last election, the hon. Gentleman and most of his colleagues subscribed to the Labour party statement in its manifesto that it would abolish the rating system. Is that fact or fiction?

Mr. Gould: I can understand why the hon. Gentleman is puzzled, because he is flatly wrong. [Interruption.] Yes, he is.
That is the point that we were trying to make earlier today—that this money should be used to abolish the poll tax. To help the Government, we have published our poll tax abolition Bill—here it is—setting out the means by which we can ensure that this year's poll tax bills will be the last. We offered our co-operation to the Government in speeding the Bill through the House.

Dame Elaine Kellett-Bowman: What about widows?

Mr. Gould: I will come to widows in a moment, if the hon. Lady will be patient.
We have taken the logic of the Minister of State's measure and applied it to the more direct and comprehensive solution of replacing the poll tax by a fair rate scheme.

The Minister for Local Government and Inner Cities (Mr. Michael Portillo): I have been trying to follow the hon. Gentleman carefully, and I think that I have understood him to say that he wants to take the money from the community charge reduction scheme and apply it to produce lower rates bills under his scheme. If I had understood him correctly, how does he square that with the document "Opportunity, Quality, Accountability", which says that Labour would introduce transitional measures right from the start? I do not understand how those two positions are consistent.

Mr. Gould: The transitional provision is included in our fair rates proposals to deal with matters such as the unified business rate. That is where we make it clear that we will provide transitional relief. No transitional relief is required under our scheme, because it produces bills which are, on average, £140 lower for each household.

Dame Peggy Fenner: Will the hon. Gentleman give way?

Mr. Gould: In a moment.

Dame Peggy Fenner: The hon. Gentleman does not want to give way to me.

Mr. Gould: Yes, I will: the hon. Lady simply has to be patient.
I fear that, instead of the honest and straightforward measure that we have proposed, we are promised instead a consultation paper, which the Secretary of State tells us —perhaps he has changed his mind—will set out a number of preferred options.
My information is that the consultation paper will so far accommodate all that range of preferred options that a separate page is to be handed over to each member of the Cabinet. I understand that there will be a page for the Secretary of State for Scotland and the Secretary of State for Wales in which they will set out their proposals for different schemes in different parts of the United Kingdom. Special pages will be embossed in honour of those members of the Cabinet—the Home Secretary, the Secretary of State for Health and the chairman of the Conservative party —who have made such sterling contributions to the current difficulties.
The paper will contain an honorary page which will be handed to the right hon. Member for Finchley (Mrs. Thatcher), in which she will say that she at last concedes that she was wrong to introduce the poll tax and now wholeheartedly supports the notion that it should go and should be replaced by a property-based tax. The right hon. Lady will say that she looks forward to being whipped on a three-line Whip through the Lobby in support of the new measure. I understand that that page will contain dissenting footnotes from the Minister of State and the Under-Secretary of State in which they will make clear their continuing adherence to the principle of the poll tax, a principle that they have often supported in the House in the most glowing terms.
I fear that the Secretary of State for the Environment will have not one page but several in which he will set out at length all the ideas that he has produced in such profusion over the past decade. The ideas are contradictory, but no doubt he will feel obliged to put them before us. At the culmination of the document will be the page devoted to the Prime Minister's contribution. Of course, it will remain blank.
That brings us to the cost of the scheme, and the use to which we would put that money under the fair rates scheme. We assume that sum, for the purpose of our calculation, to be about £1 billion, but I am happy to accept whatever figure the Minister of State wants to suggest. As we made clear last week, that money, together with the money saved on administrative costs and on higher collection levels, would be applied to an improvement in central Government grant so that average bills would be lower by about £140 per household. In that calculation, we have compared like with like, headline bill with headline bill.
No one has seriously or effectively challenged our arithmetic. Quite the reverse, because the Chartered Institute of Public Finance and Accountancy and others have confirmed that our arithmetic is impeccable. [Interruption.] Conservative Members may be interested to hear the next part of my speech, in which I shall attempt to deal with the Government's complaint. They complain that we have been unfair in our calculations, because we have taken the benefit of the cost of this scheme and applied it to reduce our headline bills but have not allowed a similar reduction in their headline bills. We have been straightforward and have made it clear that we are comparing headline bills with headline bills.

Mr. Portillo: The hon. Gentleman claims to have compared headline bill with headline bill. On "Today" on Radio 4, he said:
What we're talking about is a household bill which would be £140 lower than that same household would pay under this year's poll tax provision.
That is not a headline bill, and it is not a reduction of £140 in what people are paying under this year's provision. What the hon. Gentleman said on that programme was absolutely wrong, and he is now trying to cover it up by claiming that he compared headline charges. He did not.

Mr. Gould: The Minister of State will have an opportunity to develop that point. Our statement makes it clear, and I do so again, that we are comparing headline bills with headline bills. I am happy to deal with the Minister of State's point, but I rather suspect that Conservative Members will not be happy when I have done so. If the Government want to compare the bills that are payable, I am happy to join in the exercise, because the Minister of State would then be in a rather different difficulty.
If we consider the bills payable, it is not just the transitional relief that must be taken into account; the question of the rebate must be added to the reckoning. The big difference between the Government's poll tax bills and our fair rates bills is that, when the Government reduce bills under their reduction scheme, they pocket the very substantial savings they make on rebate. When we reduce the headline bill by much more than they are doing—by an average of £140 per household —we will redistribute the money saved on rebate and apply it to an extension and improvement of the rebate scheme that will benefit the very widow about whom the hon. Member for Medway (Dame P. Fenner) is so concerned. That is why the bills that will actually be paid under our scheme will be substantially lower than the headline bills.
Because the Government are not sure of their figures, it is difficult to calculate the sums involved. If the Minister

would like to offer us some figures, we would be delighted to confirm our calculation. It is a reasonable assumption that the £140 advantage that we have shown in the headline bill per household will at least be maintained when both transitional relief and rebates are taken into account.

Mr. Beith: Why did not the hon. Gentleman tell us in his announcement last week what rebates would be available under his proposal, how much money he thinks can be channelled from the scheme to provide rebates, and where that money will come from?

Mr. Gould: The hon. Gentleman and I have exchanged correspondence on that matter, and I continue to be puzzled about why he finds it difficult. We have been clear about our position, and I am happy to restate it now. Unlike the Government, we will not pocket the savings on rebates; we will spend exactly the same amount net as currently goes to rebates, but because of the savings and because of their redistribution we can extend the scheme substantially and improve it. That is how we can help the widow and do away with the 100 per cent. contribution.
Our challenge to the Government —who are introducing a confusing and expensive package whose only claimed merit is that it reduces some bills to an approximation of rates bills—is, why make do with the approximation? Why not have the real thing? Why not have the savings on both headline bills and bills payable, which would flow from our fair rates scheme, as soon as possible? Let us forget the nonsense of transitional relief, and apply the money to fair rates. The Government should take up the Bill that we published today and use it to get rid of the poll tax now, once and for all. The pity of it is that the Government do not have the courage or the will to take that simple step. That is why we shall vote against the regulations tonight.

The Minister for Local Government and Inner Cities (Mr. Michael Portillo): This has already been a worthwhile debate. One can scarcely believe that we are debating a prayer—a subject chosen by the Opposition. The hon. Member for Dagenham (Mr. Gould) put his foot in it two or three times during his speech. We now know that there is to be no transitional relief scheme under Labour's proposals. That is scarcely consistent with the document "Opportunity, Quality, Accountability" which talks of introducing transitional measures from the start. I find that puzzling. Possibly the hon. Gentleman has a ready-made document, or perhaps he misheard the cue from the hon. Member for Dewsbury (Mrs. Taylor).
The hon. Gentleman has tried to wriggle out of something that is quite clear. He made a false comparison on the "Today" programme on Radio 4. He has been caught out. He can assert as often as he likes that he was comparing headline figures, but the record stands—he did not say that. He was quoted on Radio 4 as saying something different.
The scheme that we are discussing brings great relief to many community charge payers, who will note with interest that the Labour party is this evening voting against that relief. The community charge reduction scheme is now extremely straightforward and simple. To answer the point of order raised by the hon. Member for Berwick-upon-Tweed (Mr. Beith), there is indeed a


difference between the original and the corrected versions. A multiplication sign becomes a plus sign—an important difference.
For every couple in future, the increase as between the community charge bill and the old rates bill will be limited to just £52. For every additional eligible adult another £52 threshold is added —

Mr. Gould: The Minister used the word "every". He may recall, if he was listening to what I said, that I invited him to comment on a number of categories of people who I suggested would fall outside the scheme—for example, those who become 18 during the course of this year, or people who move house this year, or people who formerly lived in houses that were not liable to rates. Will he confirm that those people are outside the scheme? If not, how are they brought within it?

Mr. Portillo: Yes, there are a number of categories of such people who are outside the scheme.
The operation of the scheme is not so difficult as some people would like to make out. In fact, some local authorities —10 at the last count, including Watford, Trafford and, I am thrilled to say, Barking and Dagenham —have already sent their bills out net of the general reduction of £140 and net of the community charge reduction scheme.
The Personal Community Charge (Reductions) (England) Regulations 1991 bring into effect the changes that we announced last January. They therefore take over where the transitional relief scheme left off, but with some important changes, including special rules created for people living in sheltered housing so that their reduction can be calculated on the basis of their share of the total rates bill. Tonight, the Labour party is voting against reductions for such people. The Personal Community Charge (Reductions) (England) (Amendment) Regulations 1991 simply correct one of the formulae used in the calculation of the reduction for people living in sheltered housing.
Although not the subject of the debate today, of critical importance is the second amending set of regulations—the Personal Community Charge (Reductions) (England) (No. 2) Regulations 1991. These regulations account for the most recent changes, which are: an even lower threshold of £52; more help for larger families and people living in groups of properties covered by one assessment only—they will not have to pay more than the 1989–90 rates bill plus £52 for the first two eligible people and a further £52 for each subsequent eligible person; people who moved in 1990–91 and who lost their entitlement to transitional relief may now enter the reduction scheme at their new address.
An example might be helpful at this point. As the hon. Member for Dagenham was fair enough to point out, following the £140 reduction those eligible for a reduction under this scheme have to pay only the 1989–90 rates, calculated as the rateable value for their property, multiplied by the average rate poundage for their areas, plus £52 for the first two people and a further £52 for every successive eligible person.
So three eligible people living in a terraced house in Pendle for which the rates were about £200 may have to pay in total only £304—that is, £200 plus £52 for the first two people and another £52 for the third person. Each

individual's liability—before any community charge benefit is calculated—will be only just over £100 compared with Pendle's revised charge of £218.
About 7 million people benefited from transitional relief last year, but an estimated 16 million people will benefit from this scheme at a cost of just over £1·2 billion. This brings the average charge before the calculation of community charge benefit to £220. Let us consider how this compares with Labour's careful analysis.

Mr. David Wilshire: As well as giving us hypothetical examples from wonderful places north of Watford—such as Pendle—will my hon. Friend reflect on a constituency case of mine? A constituent in Surrey recently wrote to me saying that he faced a charge this year of £1,161, which he said was outrageous. I was able, however, to write this afternoon to tell him that under the proposals that the Government have produced his family of three would have to pay only £534—so my hon. Friend's proposals have saved my constituent and his family £627. Is that not better than anything that the Labour party could come up with?

Mr. Portillo: My hon. Friend has produced a remarkable example. When he next writes to his constituent he will presumably be able to write as a postscript that the Opposition voted against the giving of that relief.

Mr. Gould: Does the Minister agree that the example of the hon. Member for Spelthorne (Mr. Wilshire) showed how outrageously high poll tax bills became and how substantially reduced a real rates bill would have been for the same family?

Mr. Portillo: The hon. Gentleman has failed to respond, despite several interventions, to the case of those who benefited substantially from the community charge. I think especially of single widows. They have no need of the community charge reduction scheme because they are doing better under the community charge than under the rating system. When the hon. Gentleman proposes that he should take us back to rates, with no upper limits, no protection and no transitional relief, he is saying that single widows should be taken back to and beyond enormous rates bills. He has no solution to that problem. He does not care about single widows. He has explicitly ruled out any relief for them, or any reduction for single people generally. He is on poor ground.

Mr. Richard Tracey: My hon. Friend has made an interesting but obvious comment about the unfairness of the rating system. He will recollect that a few years ago the Leader of the Opposition said categorically that that system was the unfairest tax that was ever invented and that it should be abolished forthwith. Has my hon. Friend any recollection of when the Leader of the Opposition contradicted that statement?

Mr. Portillo: The Leader of the Opposition prefers not to talk about local government finance. When he addressed his party's local government conference, he used about half a sentence to describe the so-called fair rates policy. I do not know whether that is because he does not understand it or because he is not satisfied with it. I cannot think of any occasion on which he has disowned his statement about rating policy.

Mr. David Winnick: If the poll tax is so splendid, why are the Government attempting to abolish it? Why is there so much disarray within the ranks of the Tory party? Why is the poll tax not being retained as it is?

Mr. Portillo: The House was discussing disarray within the Labour party. We were discussing why the Leader of the Opposition described rates as the unfairest of all taxes and is now proposing to return to them.
I take up what the Labour party has said about "fair rates". It claims that the average bill per household will be £333, and that that will represent a saving of £140 over the average paid in community charges. It is wrong on two counts. First, the average bill should be about £360, not £333. The Chartered Institute of Public Finance and Accountancy has confirmed these figures. It has said that Labour's scheme would need to raise £6·7 billion of income from the domestic ratepayer and that the average bill would be £358. The CIPFA figures deduct from what is raised now £1·25 billion of grant from the community charge reduction scheme and putative savings of £400 million on the cost of collecting the tax. They do not bear out the Labour party's figures. The CIPFA figures are at variance with the Labour party's figures by £25 per household.
The Labour party has made a mistake in the first part of the calculation of £400 million, but it does not end there. The figure that describes the saving of the average household is also wrong. The Labour party has taken out the money that goes into the community charge scheme to produce lower rates bills, but it has not allowed for that money when dealing with the average bill now being paid under the community charge. It has assumed that the average household now pays £473, but households pay only £394 on average once the community charge reduction scheme has been taken into account. The £66 difference is a saving that people are already making under the Government, not an extra saving that they would make under Labour's policy. That eliminates another £79 of Labour's savings.
I heard loud and clear what the hon. Gentleman said this evening and I also heard what he said on the radio, where he misrepresented the facts. I have what he said in black and white. Is he denying the transcript of his radio broadcast or saying that it is wrong?

Mr. Gould: The document that we published at our press conference made it clear—indeed it was so clear that it was in the first paragraph—that we were comparing headline bill with headline bill. Apparently the Minister of State did not understand what I said, or chose not to understand. I made it clear that if he wants to compare bills paid with bills paid the advantage is there in similar measure. He would have to take account not only of transitional relief, but of the superiority of our rebate scheme. I shall be interested to hear what he has to say about how much is saved on the rebate scheme by virtue of the transitional relief scheme.

Mr. Portillo: I can tell that the House is in a generous mood this evening. If the hon. Gentleman cared to apologise for his mistake, the House would accept that. He could say that he was speaking on the radio and did not mean to be misleading. He said:

What we're talking about is a household bill which will be £140 lower than that same household would pay under this year's poll tax provisions".

Mr. Gould: That is right.

Mr. Portillo: That is not right; it is absolutely wrong.

Mr. Gould: rose—

Mr. Portillo: What a household pays under this year's poll tax provisions must take account of the reductions being received by 16 million people under the community charge reduction scheme.

Mr. Gould: The Minister of State persists in either failing or refusing to understand the point that I made at the beginning of the debate. I said that if we are to consider bills paid, the Minister cannot stop merely at taking account of his pet transitional relief scheme in calculating the bills paid. He must also take account of the rebate scheme. As the rebate scheme is substantially reduced by the transitional relief scheme, and as we propose to recycle that money and ensure that every penny is used for rebates, when we regard both of those factors my statement stands. If that is not the case, let the Minister of State dispute the arithmetic.

Mr. Portillo: My advice to the hon. Gentleman is, "When you are in a hole, stop digging". The record of what the hon. Gentleman said on the radio is clear. The House has seen him wriggling today, but he cannot undo what he said on the radio.
The Labour party's figures are wrong by £104 per household. The remainder of its assumed savings could equally arise under any new local tax. It is claiming savings from collection costs on the assumption that all the debts from the community charge system are written off. That could be claimed for any tax system. When it comes down to it, the Labour party is offering savings that people are already receiving and which might be claimed for any new local tax. Its figures are bogus.
Let us cast such mathematical quibbles to one side. Labour party policy is, as the hon. Gentleman said, to take the money available through the community charge reduction scheme and redirect it through the grant system to all local authorities. The hon. Gentleman confirmed that.
The Labour party would take away targeted help from those who need it most—those who faced the largest increases on moving to the community charge—and spread it around. Of course, that help under Labour would be targeted on Labour councils. The money that now goes to reduce bills would be used to support even higher levels of spending by councils. We know where the highest levels of spending are —they are in Labour councils. That is Labour's way for local government.
I must again remind the hon. Member for Dagenham of the statement made in "Opportunity, Quality, Accountability" that there will be transitional measures "right from the start". He now denies that this will apply to the new scheme and says that it is meant to apply only to the business rate. I therefore have two charges against the hon. Gentleman. First, Labour policy on this issue is thoroughly confused and the hon. Gentleman gives a passable impression of not having read his own policy document. Secondly, he is unwilling to offer any protection to anyone, whether single people or widows, when he proposes to move people back to their rate bills.
What is more, if there is to be further transitional relief under the business rate—as we now understand the hon. Member for Dagenham to be saying —may we know where that money will come from? Will it be raised separately? Will it be added to VAT? Will it be raised from income tax? Will it be imposed on domestic ratepayers? Will it be raised from higher business rates for other people? [Interruption.] I am asking the hon. Member for Dagenham a question. Instead of laughing, he should think about how the scheme will be financed. If, as I understand it, there is to be transitional relief for business payers, where will the money come from?

Mr. Gould: I was laughing because I was astonished at the Minister's brass neck. He represents a Government who introduced a transitional relief scheme for their own nationalised business rate which was financed by business ratepayers.

Mr. Portillo: It is not easy to get answers tonight. I take it that this is a further impost on those who pay business rates who would otherwise gain from the move to the uniform business rate. [Interruption.] The hon. Member for Dagenham nods. It is a further impost on those businesses that would otherwise gain.

Miss Emma Nicholson: Does my hon. Friend agree that the hon. Member for Dagenham (Mr. Gould) has made it clear that a heavier burden will be imposed on local people through domestic rates to pay for higher council spending? As the hon. Gentleman said on BBC Radio 4 on 26 March this year, the amount will go up to 20 per cent. The hon. Gentleman fudged the issue by pretending that it is the same as the current level. That is not true.

Mr. Portillo: Indeed. The hon. Member for Dagenham claimed that the appropriate amount to raise from local taxation was 20 per cent We have reduced it to 15 per cent. My hon. Friends may remember that the Labour party was very much against the increase in VAT that enabled the reduction from 20 per cent. to 15 per cent. to be made. Labour Members want to have it both ways. They now want to claim that the new tax should be based on 15 per cent. even though they were so dismissive of the idea of putting it on VAT. If they do not want it on VAT, does that mean that we are to go back to 20 per cent. funding from local taxpayers, or will the money be raised in another way?

Mr. Gould: rose—

Mr. Portillo: I shall give way for the last time. I must let others speak in the debate.

Mr. Gould: I am grateful to the Minister for giving way so generously as he is again trying to misrepresent what I said. The Minister, the Secretary of State and the hon. Member for Torridge and Devon, West (Miss Nicholson) should get their act together. We should at least be talking about common definitions. If they care to check the statement made to the House by the Secretary of State on 21 March, they will see that he proudly claimed that the sum raised by the poll tax had been 34 per cent. but because of the switch in the Budget had been reduced to 22 per cent. Let us at least have some consistency in the use of these figures.

Mr. Portillo: I did not hear the hon. Gentleman answer the question. If he is against the VAT increase, where will the money come from?
The regulations offer real help to people who need it. It is valuable help, costing £1·25 billion. It is help to a large number—16 million people. This evening, the Labour party will compound a wretched evening for itself by voting against the regulations. I commend them to the House.

Mr. Michael J. Martin: Conservative Members talk about confusion in the Labour party. For the past year, I have seen a great deal of confusion in the Conservative party. I watched English hon. Members go into the Division Lobby without losing a wink of sleep to put the poll tax in Scotland. When they realised what they had done in England, they brought about the downfall of the then Prime Minister. Bit by bit, they are now backing off from the poll tax.
We are debating the poll tax tonight because Conservative Members are worried about the municipal elections and the effect that they will have on Conservative councillors. I hope that, for the sake of people who are suffering real hardship throughout the country, they will get rid of the poll tax. Let us forget about the £144 under discussion tonight. Conservative Members must know that elderly people and widows are coming to our surgeries and saying that, under the rating system—bad as it was —they could depend on rebates. Now they are worried and do not know whether they are coming or going.
The Minister spoke of "single widows". What can a widow be but single? He said that no one has given assurances about widows, but he must know that, if a widow resides in a house with four or five adults in the household, under the poll tax system she will be worse off than she was under the rating system. In Strathclyde the poll tax is £350. I know of no widow with sons and daughters who is in a better position under the poll tax system. Widows who live alone may be in a different position, but I should have thought that the rating system could cope with their situation under a rebate scheme.
The Minister must know that the terrible system whereby sons and daughters leave the household and refuse to register puts mothers and fathers in a distressing position. For the first time in their lives, they have debt collectors coming to their doors. People who prided themselves in never having had debts are now threatened with warrant sales. The Secretary of State for Scotland said that local authorities such as Strathclyde should have more warrant sales. Warrant sales are being implemented in Strathclyde as a result of mistakes by the local authority, when people have paid their poll tax through bankers orders and the money has been credited to other people. People have then been threatened with messenger-at-arms officers.

Mr. Jacques Arnold: Incompetent Labour councils.

Mr. Martin: The hon. Gentleman must know the terrible pressures being put on councils, whether they are Conservative or Labour.
Much of the talk about and the attacks on local authorities, regardless of their political persuasion—

Mr. Jacques Arnold: Will the hon. Gentleman give way?

Mr. Martin: I shall not give way to the hon. Gentleman because the Front Benches have taken up more than half the debate. The hon. Gentleman can take his chances.
Conservative Members' remarks do a disservice to councillors throughout the country. They must know that councillors do an excellent job. They take care of social work problems, look after the local authorities on a voluntary basis and, when they get home at night, are pestered with phone calls and must attend numerous meetings in their wards. When the Minister talked about local authorities, he did not mention that. A disservice has been done.
I also believe that the poll tax has brought out the charlatans, the organisations that run around collecting money under false pretences. One organisation, known as the All-Britain Anti-Poll Tax Federation, has received thousands of pounds from the poorest of the poor. It has organised demonstrations, but I do not hear a word from the Minister about investigating where that money goes.
The All-Britain Anti-Poll Tax Federation in the west of Scotland has turned up to school meetings all over Strathclyde. It has collected money under the pretext that it will go to fighting the poll tax and no one knows where that money goes. Some of it has been directed into getting people involved in violent demonstrations in Trafalgar square. The Scottish Nationalists do not come out of the affair very well because some of them—Members of Parliament—have graced the platforms of such organisa-tions. They have turned up in my constituency, telling the poorest of the poor not to pay their poll tax when they know that the worst thing that can happen to people is to get deeper and deeper into debt.
The poll tax has brought out the worst elements in our society who are prepared to exploit people who are living in poverty—[Interruption.] Hon. Members talk about the Labour party. There are respectable men and women in the Labour party who are on record as saying that, regardless of whether or not this is a bad law, people must obey the rule of law. I shall go on record as saying that. It is wrong for hon. Members to name a few Labour Members and say that their behaviour is typical of all of them.
I do not say that Lady Porter, who sells off a graveyard to developers, is typical of Conservative councillors—far from it. Therefore, why should Conservative Members smear Opposition Members in that way when they know that they are decent men and women?

Mr. Jacques Arnold: Will the hon. Gentleman give way?

Mr. Martin: I shall not give way to the hon. Gentleman —I have given my reason.
Badness comes out when a bad law is brought in. There was a by-election in Scotland where Scottish Nationalists told people on their doorsteps not to pay their poll tax. When asked by the media, the Scottish Nationalist candidate said, "If I am pushed to a warrant sale I will bring out my cheque book and pay the poll tax." Some of my constituents whom the Nationalists encouraged not to pay their poll tax do not have the luxury of bringing out a cheque book and paying their way out of the problems. When bad law is introduced, it brings the House into disrepute, and the poll tax has done that.

Miss Emma Nicholson: I am shocked beyond measure to learn tonight from the hon. Member for Dagenham (Mr. Gould) that Her Majesty's Opposition will not vote in favour of the community charge reduction scheme. I believe that there is a certain sad consistency in that dreadful statement. I cannot accept that Labour party members are, in their hearts, committed to cheap, effective and accountable local government. If they were, whether the scheme benefits 8 million, 18 million or 28 million people, it will still be a scheme that gives financial help to people who have found life with the community charge tough.
It is inconsistent and hypocritical of the Labour party to say, on the one hand, that it cares about the poor and, on the other hand, to fail to support the community charge reduction scheme. I am ashamed of its Members; I think their action is disgraceful. I have spent much of my adult life working for the poor. However, hypocrisy may not be the only hallmark of the modern Labour party, Her Majesty's Opposition. I believe that there is a flaw in their acceptability as a potential Government by virtue of their financial incompetence.
The Labour party was foolish enough to go into print. When one goes line by line through its documents that state how it intends to bring about a fair rates system, one sees that beneath those bold statements lie hypocrisy, inconsistency, incompetence and inaccuracy. I make strong statements because I have a local government background. I know about local government finance. I designed systems that led to accountability to the local electorate. While carrying out that work I found that the least competent and, therefore, the most expensive councils—the ones that paid through the nose for work that ought to have been done very economically —were, alas, those that were powerfully controlled by the Labour party.
Reference has already been made to the Labour party's difficulty over understanding the difference between 27, 15 and 20 per cent. When we calculate percentages we use different bases, according to the point that we are discussing. The assumption of the hon. Member for Dagenham is fundamentally flawed. I made that point earlier.
The Labour party assumes that councils will spend the same amount as they have set in their budgets. That is such a naive statement that it hardly bears consideration. We know that Labour council figures do not reflect the long-term effects of very high spending. A more important point is that the Labour party assumes that
Government grant is redistributed among councils on the fairer equalisation basis set out in 'Fair Rates'".
I leave aside the obvious point that Labour failed to tell us what form its grant distribution formula would take. The Labour party says that it is consulting on its alternatives, yet it knocks the Government for consulting. It is a curious "Alice in Wonderland" state of affairs when a word means just what one wants it to mean, according to how one uses it.
A more important point is that, according to the fair rates document, the Labour party's proposals would not take effect for several years after the Labour party had taken office. It is therefore untrue to say that Government


grant would be redistributed among councils on the fairer equalisation basis set out in "Fair Rates." That would provide no help for two or three years.
The Labour party proposes that first there should be a return to the old rating system. That would be very difficult. Some of the rating lists are 10 or 20 years out of date. In a few places in my constituency revaluations have not been made since 1967. How, therefore, on page 3 of "Fair Rates: Labour's Alternative to the Poll Tax" can the Labour party say that the first thing that it intends to do is to modernise the rates by using that list? It also says —this is the untruth at the heart of that paper—that it would make them fairer by relating them to ability to pay. The Labour party offers a menu that will taste very bitter if the electorate is foolish enough to want to taste it.
The Opposition say that the timing of the changes will depend on the situation that they inherit and, in particular, on the resources that are available. They go on to detail a stream of people whom they intend to help in the long run. On top of that, they go into some detail in identifying what they call a property tax linked to ability to pay. That, I believe, is meant to be their fair rates system. They say that they will modernise the rating system immediately. We are told that they will instantly make it fair by relating it to ability to pay. In fact, what they outline on page 4 of this massive, inconsistent and frightening document is the effect of major, centralised computerisation. They say:
We have considered the potential of the Inland Revenue's increasingly sophisticated computerised data base as a highly efficient and responsive way of linking tax liability to ability to pay.
They may have considered it; clearly, they do not know how it works. It is indeed a highly sophisticated, highly economical means of collecting the inland revenue, but it would take years to alter it to do what Her Majesty's Opposition want it to do—pick up the possibility that
means-tested rebates could be replaced by an automatic calculation of liability, using information already available.
We are told that the system
could even preserve confidentiality and require the disclosure of no new information.
Here we go:
Properly designed, it could be an important step towards a much wider reform encompassing the benefit system as well as taxation, and offering the prospect of a single tax-benefit transaction between the individual and the Government.
When I raised this matter just before the Easter recess I was assured by Opposition Members that they had no intention of centralising information on citizens in this way. Yet this is what they offer. This is what is supposed to preserve confidentiality and personal privacy and to keep people from worrying. This is their way of creating what they call the fair rating system. It would take a 10-year programme to bring all these things together in a recomputerised format. We would end up with a system cutting right across the principle that confidentiality and individuality should be preserved to some degree. The way to preserve confidentiality and individuality is to keep these two wings of the Government's work apart. That has always been the basis of our society's thinking. But, at a stroke—or, rather, with a few lines on a word processor —the principle is cast aside. What is on offer is not a fair rates system; it is a return to the old burdensome rating system, based on an antiquated list which is 30 years out of date.
This Labour party document is not just full of flaws; it is a fudge, a mudge and an example of utter hypocrisy. I am no longer surprised that Her Majesty's Opposition will

not vote for something that will benefit the electorate. Last time, they did not press the matter to a vote, but tonight they will do so. All that they are able to offer is something that should be discarded before it can see the light of day. I wish that they would either be honest and say that their paper has no validity in our society, or sit down and shut up.

Mr. A. J. Beith: These regulations are before the House tonight because the poll tax was never related to ability to pay. In the case of many people on moderate incomes, large bills were not abated satisfactorily. Help was available only at the lowest income levels. High-spending Labour authorities were not the only ones to send out large bills; people in Conservative-controlled areas like Harrogate and Warwickshire had to face the same problem; and people throughout the country were getting bills that, in terms of the national average, were of medium size. They produced levels of tax which it was unreasonable to ask people of modest incomes to pay; they were often much higher than the families had faced under the rating system.
One response would be to try to relate the system wholly to ability to pay. The Government response has been other than that: it has been to change their whole policy on the balance of local and central expenditure so as to get the basic charge down. That may be only a temporary measure until they have produced the scheme which they may tell us about tomorrow, but that is the purpose of the regulations.
Intriguingly, it is also the purpose that has been pursued by the Labour party. It has concentrated considerable effort on trying to produce another and significant decrease in the overall charge for everybody. Of course, such schemes have the effect of providing a reduction for those who are big gainers from the poll tax as well as for those who are big losers. They benefit the poor less than the rich, because some of those at the bottom of the salary scale cannot gain £140 from the system. It would have been far better for the Government to go from the start for a system related to ability to pay.
What has become even more puzzling tonight is why the Opposition, in their criticism of the whole thing, have not made it clear how a proper rebate system can be. grafted on to what they are proposing. It has become the great Labour rebate mystery. The fair rates document indicated that, under Labour's proposals, rebates would be introduced as resources allowed, depending on the position that was inherited, rather than being made integral to the scheme from the start.
What has been wrong with the poll tax all along is that ability to pay has not been integral to the scheme. That is why I and my right hon. and hon. Friends so strongly favour a local income tax, which would be based from the beginning on ability to pay. That fundamental defect cannot be solved by the Government's proposals. That said, so far into the charging year, the House would be mad to throw out the £140 relief. That would be a crazy thing to do.

Mr. Rupert Allason: rose—

Mr. Beith: So little time has been left for me that I cannot reasonably give way.
Throwing out the £140 relief would be denying to those people who have been hardest hit by the scheme the only relief on offer. Therefore, I cannot invite my right hon. and hon. Friends to vote for the prayer and to attempt to throw out the scheme, however deficient it is in some important respects.
There is a second reason, however, why I do not want my right hon. and hon. Friends to support the prayer. The Government scheme also incorporates something that I have been pestering Environment Ministers to do ever since they dreamed up the first transitional relief scheme; that is, to make provision for people living in sheltered housing schemes. I have been to meetings and on deputations to try to persuade the present Ministers and their predecessors that it was wrong that people living in sheltered housing schemes should not have had the benefit of transitional relief. It was the main means by which the Government sought to abate poll tax bills.
Many people in sheltered housing schemes are those who most deserve that help. Thank goodness they are at last getting it. It happens that, at the time they are getting it, they will also be getting the additional benefit of the £140 relief to the extent that they are eligible for that as well. So the immediate effect will not be as noticeable, but it is putting right an injustice of the transitional relief scheme since it started.
We are in an odd position, because we are debating two sets of regulations, although three are floating around on the subject. The one which is not before us actually amends the regulations that we are considering. Indeed, things that we pass tonight will be undone in the technical sense by statutory instrument 844. It would have been more helpful if we could have considered all the regulations at one go and if a group of prayers had been tabled by the Opposition to cover all three.
Those technicalities, along with the abstruse formula which has had to be corrected, will not be most evident to the people who are desperate for some relief from the terrific burden of the poll tax. This is the only relief on offer. What a crude mechanism it is, and how crude too is the mechanism which Labour has suggested as an alternative. We should have a local tax related to ability to pay. That is what a local income tax would provide.

Mr. David Blunkett: If we voted for every scheme and every proposal put to the House that had a grain of good in it we would never vote against anything. It is on those grounds that we shall vote against the regulations tonight.
The proposed scheme is flawed. It does not target help according to ability to pay, but relates help to previous rate bills. On 17 January we were told that the changes would cost £1·7 billion and that 18 million people would benefit. On 24 January, however, the Prime Minister said that any scheme that involved having to give a discount or rebate to more than 50 per cent. of the population was fundamentally flawed and would not last, so we have the right hon. Gentleman's word that we should not vote for the regulations tonight.
On 19 March the Treasury admitted that the £140 reduction would cost £4·5 billion and that a clawback of £1·25 billion was necessary from the scheme that we

discussed today and from rebates to fund that reduction. On 12 April, however, the Secretary of State told us that £1·25 billion was the cost of the scheme. That means that £800 million will have to be clawed back from somewhere in the rebate system.
The proposed scheme is flawed because it does not target help according to ability to pay. It is not related to the rebate system, which would perform that precise job. It does not tackle the 20 per cent. contribution, which penalises the very poor, and it is certainly not aimed at helping widows. One Conservative Member kept on crying out about widows during the speech of my hon. Friend the Member for Dagenham (Mr. Gould). The way to help widows is to ensure that the bills which have to be paid are directly related to the income of the person. We are not into helping Jacquie Onassis pay her bill under a blanket scheme. We shall help those who need assistance.
The regulations in SI 844 extend the scheme to families with three or more individuals living in the property, even though the Conservatives will announce next week that they want to target help on individuals living alone.
The scheme is absolute nonsense. The Chartered Institute of Public Finance and Accountancy has confirmed time and again, including in a letter from Noel Hepworth on Monday, that it agrees entirely with our arithmetic. It issued only one qualification and The Times got it wrong. It said that, as part of its constitution, it would never endorse any national party. Our scheme stands up to scrutiny. We shall target our help on those who need it most.
If the community charge reduction scheme had been operating 20 years ago, one individual would have had great difficulty in claiming the rebate, because that individual would have had great difficulty in identifying which local authority he lived in. That individual would have been the resident of No. 10 Downing street.

The Parliamentary Under-Secretary of State for the Environment (Mr. Robert Key): The saddest thing about tonight's debate is that it is not being held in prime time with a packed House so that the public could hear exactly what has been said by Opposition Members, mistake after mistake and fluffed line after fluffed line. The Opposition have denied what they said on radio and television. It has been an extraordinary event.
The hon. Member for Sheffield, Brightside (Mr. Blunkett) talked about a grain of good, and some grain it is—about £1·2 billion worth. The hon. Gentleman dismisses 16 million people with a reference to a grain of good. Tonight 16 million people will hear that Labour has voted against their relief. As the Opposition vote against that relief scheme, CIPFA and the Institute of Revenues, Rating and Valuation will be busy distancing themselves even further from Labour's scheme.
I congratulate the hon. Member for Glasgow, Springburn (Mr. Martin) on his courageous speech, which it must have been difficult to deliver. He was right to talk about the violence that has been caused by those who have refused to pay their poll tax. It is interesting to note that the Scottish National party was absent from tonight's debate and it fell to the hon. Gentleman to make that courageous speech. He talked about a disservice to councillors. I do not think that there is any such disservice in what the Government are trying to achieve. We are


trying to ensure that there is a proper partnership between central and local government. That is crucial if local councillors as well as central Government are to work in proper partnership on behalf of all the people whom we represent.
My hon. Friend the Member for Torridge and Devon, West (Miss Nicholson) made a telling speech about the fundamentally flawed Labour policy. The hon. Member for Berwick-upon-Tweed (Mr. Beith) was his usual generous self when commenting upon the sheltered housing schemes, and rightly referred to Labour's rebate mystery.
What we have achieved in the regulations is to take into account excessive spending by authorities and we have further reduced many people's charges in our subsequent schemes to within just £52 of their old rates bills.
This has been an important measure and there are further regulations to come. The House will not have to wait long—

It being half-past Eleven o'clock, MADAM DEPUTY SPEAKER put the Question, pursuant to the Order [22 March.]

The House divided: Ayes 182, Noes 293.

Division No. 119]
11.30 pm


AYES


Abbott, Ms Diane
Duffy, A. E. P.


Adams, Mrs Irene (Paisley, N.)
Dunnachie, Jimmy


Allen, Graham
Dunwoody, Hon Mrs Gwyneth


Archer, Rt Hon Peter
Eadie, Alexander


Ashton, Joe
Evans, John (St Helens N)


Banks, Tony (Newham NW)
Fatchett, Derek


Barnes, Harry (Derbyshire NE)
Field, Frank (Birkenhead)


Barron, Kevin
Fisher, Mark


Battle, John
Flannery, Martin


Beckett, Margaret
Flynn, Paul


Benn, Rt Hon Tony
Foster, Derek


Bennett, A. F. (D'nfn &amp; R'dish)
Foulkes, George


Benton, Joseph
Fraser, John


Bermingham, Gerald
Fyfe, Maria


Bidwell, Sydney
Galloway, George


Blair, Tony
Garrett, John (Norwich South)


Blunkett, David
George, Bruce


Boateng, Paul
Godman, Dr Norman A.


Boyes, Roland
Golding, Mrs Llin


Bradley, Keith
Gordon, Mildred


Bray, Dr Jeremy
Gould, Bryan


Brown, Nicholas (Newcastle E)
Graham, Thomas


Brown, Ron (Edinburgh Leith)
Grant, Bernie (Tottenham)


Buckley, George J.
Griffiths, Nigel (Edinburgh S)


Caborn, Richard
Griffiths, Win (Bridgend)


Callaghan, Jim
Grocott, Bruce


Campbell, Ron (Blyth Valley)
Hain, Peter


Campbell-Savours, D. N.
Hardy, Peter


Canavan, Dennis
Harman, Ms Harriet


Clark, Dr David (S Shields)
Haynes, Frank


Clarke, Tom (Monklands W)
Healey, Rt Hon Denis


Clelland, David
Henderson, Doug


Clwyd, Mrs Ann
Hinchliffe, David


Cohen, Harry
Hoey, Ms Kate (Vauxhall)


Cook, Robin (Livingston)
Hogg, N. (C'nauld &amp; Kilsyth)


Corbett, Robin
Home Robertson, John


Corbyn, Jeremy
Howarth, George (Knowsley N)


Cousins, Jim
Howells, Dr. Kim (Pontypridd)


Crowther, Stan
Hughes, John (Coventry NE)


Cummings, John
Hughes, Roy (Newport E)


Cunliffe, Lawrence
Illsley, Eric


Dalyell, Tam
Ingram, Adam


Darling, Alistair
Janner, Greville


Davies, Rt Hon Denzil (Llanelli)
Jones, Barry (Alyn &amp; Deeside)


Davies, Ron (Caerphilly)
Kaufman, Rt Hon Gerald


Davis, Terry (B'ham Hodge H'I)
Lambie, David


Dewar, Donald
Lamond, James


Dixon, Don
Leadbitter, Ted


Dobson, Frank
Leighton, Ron





Lewis, Terry
Radice, Giles


Livingstone, Ken
Randall, Stuart


Lloyd, Tony (Stretford)
Redmond, Martin


Lofthouse, Geoffrey
Rees, Rt Hon Merlyn


Loyden, Eddie
Reid, Dr John


McAvoy, Thomas
Richardson, Jo


Macdonald, Calum A.
Robertson, George


McGrady, Eddie
Robinson, Geoffrey


McKelvey, William
Rogers, Allan


McLeish, Henry
Rooker, Jeff


McMaster, Gordon
Rooney, Terence


McNamara, Kevin
Ross, Ernie (Dundee W)


McWilliam, John
Ruddock, Joan


Madden, Max
Sedgemore, Brian


Mahon, Mrs Alice
Sheerman, Barry


Marek, Dr John
Sheldon, Rt Hon Robert


Marshall, Jim (Leicester S)
Shore, Rt Hon Peter


Martin, Michael J. (Springburn)
Short, Clare


Martlew, Eric
Skinner, Dennis


Maxton, John
Smith, Andrew (Oxford E)


Meacher, Michael
Smith, C. (Isl'ton &amp; F'bury)


Meale, Alan
Smith, Rt Hon J. (Monk'ds E)


Michael, Alun
Smith, J. P. (Vale of Glam)


Moonie, Dr Lewis
Soley, Clive


Morgan, Rhodri
Stott, Roger


Morley, Elliot
Strang, Gavin


Morris, Rt Hon A. (W'shawe)
Straw, Jack


Morris, Rt Hon J. (Aberavon)
Taylor, Mrs Ann (Dewsbury)


Mowlam. Marjorie
Thompson, Jack (Wansbeck)


Mullin, Chris
Walley, Joan


Murphy, Paul
Wardell, Gareth (Gower)


Nellist, Dave
Wareing, Robert N.


O'Brien, William
Watson, Mike (Glasgow, C)


O'Hara, Edward
Welsh, Michael (Doncaster N)


O'Neill, Martin
Williams, Rt Hon Alan


Orme, Rt Hon Stanley
Williams, Alan W. (Carm'then)


Parry, Robert
Winnick, David


Patchett, Terry
Worthington, Tony


Pendry, Tom
Wray, Jimmy


Pike, Peter L.
Young, David (Bolton SE)


Powell, Ray (Ogmore)



Prescott, John
Tellers for the Ayes:


Primarolo, Dawn
Mr. Allen McKay and


Quin, Ms Joyce
Mr. Ken Eastham.




NOES


Aitken, Jonathan
Brazier, Julian


Alexander, Richard
Bright, Graham


Alison, Rt Hon Michael
Brown, Michael (Brigg &amp; Cl't's)


Allason, Rupert
Bruce, Ian (Dorset South)


Amess, David
Buchanan-Smith, Rt Hon Alick


Amos, Alan
Buck, Sir Antony


Arbuthnot, James
Burns, Simon


Arnold, Jacques (Gravesham)
Burt, Alistair


Arnold, Sir Thomas
Butler, Chris


Ashby, David
Butterfill, John


Aspinwall, Jack
Campbell, Menzies (Fife NE)


Baker, Rt Hon K. (Mole Valley)
Carlisle, John, (Luton N)


Baker, Nicholas (Dorset N)
Carlisle, Kenneth (Lincoln)


Baldry, Tony
Carr, Michael


Batiste, Spencer
Carrington, Matthew


Beaumont-Dark, Anthony
Carttiss, Michael


Beith, A. J.
Cash, William


Bellingham, Henry
Channon, Rt Hon Paul


Bellotti, David
Chapman, Sydney


Bendall, Vivian
Chope, Christopher


Bennett, Nicholas (Pembroke)
Clark, Dr Michael (Rochford)


Biften, Rt Hon John
Clark, Rt Hon Sir William


Blackburn, Dr John G.
Clarke, Rt Hon K. (Rushcliffe)


Blaker, Rt Hon Sir Peter
Colvin, Michael


Body, Sir Richard
Conway, Derek


Bonsor, Sir Nicholas
Coombs, Anthony (Wyre F'rest)


Boscawen, Hon Robert
Coombs, Simon (Swindon)


Boswell, Tim
Cope, Rt Hon John


Bottomley, Peter
Cormack, Patrick


Bottomley, Mrs Virginia
Couchman, James


Bowden, Gerald (Dulwich)
Cran, James


Bowis, John
Currie, Mrs Edwina


Boyson, Rt Hon Dr Sir Rhodes
Davies, Q. (Stamf'd &amp; Spald'g)


Brandon-Bravo, Martin
Davis, David (Boothferry)






Day, Stephen
Hogg, Hon Douglas (Gr'th'm)


Devlin, Tim
Hordern, Sir Peter


Dickens, Geoffrey
Howard, Rt Hon Michael


Dicks, Terry
Howarth, Alan (Strat'd-on-A)


Douglas-Hamilton, Lord James
Howarth, G. (Cannock &amp; B'wd)


Dover, Den
Howells, Geraint


Dunn, Bob
Hughes, Robert G. (Harrow W)


Durant, Sir Anthony
Hughes, Simon (Southwark)


Eggar, Tim
Hunt, Sir John (Ravensbourne)


Evans, David (Welwyn Hatf'd)
Hunter, Andrew


Fairbairn, Sir Nicholas
Irvine, Michael


Fallon, Michael
Jack, Michael


Fearn, Ronald
Janman, Tim


Fenner, Dame Peggy
Jessel, Toby


Field, Barry (Isle of Wight)
Johnson Smith, Sir Geoffrey


Finsberg, Sir Geoffrey
Jones, Gwilym (Cardiff N)


Fishburn, John Dudley
Jones, Robert B (Herts W)


Fookes, Dame Janet
Kellett-Bowman, Dame Elaine


Forman, Nigel
Kennedy, Charles


Forsyth, Michael (Stirling)
Key, Robert


Fowler, Rt Hon Sir Norman
King, Roger (B'ham N'thfield)


Fox, Sir Marcus
King, Rt Hon Tom (Bridgwater)


Franks, Cecil
Kirkhope, Timothy


Freeman, Roger
Knapman, Roger


French, Douglas
Knight, Greg (Derby North)


Fry, Peter
Knight, Dame Jill (Edgbaston)


Gale, Roger
Knox, David


Gill, Christopher
Lamont, Rt Hon Norman


Glyn, Dr Sir Alan
Lang, Rt Hon Ian


Goodhart, Sir Philip
Latham, Michael


Goodlad, Alastair
Lawrence, Ivan


Goodson-Wickes, Dr Charles
Lennox-Boyd, Hon Mark


Gorman, Mrs Teresa
Lilley, Rt Hon Peter


Gorst, John
Livsey, Richard


Grant, Sir Anthony (CambsSW)
Lloyd, Sir Ian (Havant)


Greenway, Harry (Ealing N)
Lloyd, Peter (Fareham)


Greenway, John (Ryedale)
Lord, Michael


Gregory, Conal
Luce, Rt Hon Sir Richard


Griffiths, Peter (Portsmouth N)
Lyell, Rt Hon Sir Nicholas


Grist, Ian
Macfarlane, Sir Neil


Ground, Patrick
MacKay, Andrew (E Berkshire)


Grylls, Michael
Maclean, David


Hague, William
Maclennan, Robert


Hamilton, Hon Archie (Epsom)
McNair-Wilson, Sir Patrick


Hamilton, Neil (Tatton)
Malins, Humfrey


Hampson, Dr Keith
Mans, Keith


Hanley, Jeremy
Maples, John


Hannam, John
Marland, Paul


Hargreaves, A. (B'ham H'll Gr')
Marshall, John (Hendon S)


Hargreaves, Ken (Hyndburn)
Marshall, Sir Michael (Arundel)


Harris, David
Martin, David (Portsmouth S)


Haselhurst, Alan
Mates, Michael


Hawkins, Christopher
Mawhinney, Dr Brian


Hayes, Jerry
Maxwell-Hyslop, Robin


Hayhoe, Rt Hon Sir Barney
Mayhew, Rt Hon Sir Patrick


Heseltine, Rt Hon Michael
Meyer, Sir Anthony


Hicks, Mrs Maureen (Wolv' NE)
Michie, Mrs Ray (Arg'l &amp; Bute)


Hicks, Robert (Cornwall SE)
Miller, Sir Hal


Higgins, Rt Hon Terence L.
Mills, Iain


Hill, James
Mitchell, Andrew (Gedling)


Hind, Kenneth
Mitchell, Sir David





Moate, Roger
Steel, Rt Hon Sir David


Monro, Sir Hector
Steen, Anthony


Montgomery, Sir Fergus
Stern, Michael


Moore, Rt Hon John
Stevens, Lewis


Morris, M (N'hampton S)
Stewart, Allan (Eastwood)


Morrison, Sir Charles
Stewart, Andy (Sherwood)


Morrison, Rt Hon Sir Peter
Stewart, Rt Hon Ian (Herts N)


Moss, Malcolm
Stokes, Sir John


Neale, Sir Gerrard
Sumberg, David


Nelson, Anthony
Summerson, Hugo


Neubert, Sir Michael
Tapsell, Sir Peter


Nicholls, Patrick
Taylor, Ian (Esher)


Nicholson, David (Taunton)
Taylor, Matthew (Truro)


Nicholson, Emma (Devon West)
Taylor, Teddy (S'end E)


Norris, Steve
Tebbit, Rt Hon Norman


Onslow, Rt Hon Cranley
Thompson, D. (Calder Valley)


Oppenheim, Phillip
Thorne, Neil


Page, Richard
Thurnham, Peter


Paice, James
Townend, John (Bridlington)


Patnick, Irvine
Tracey, Richard


Patten, Rt Hon John
Tredinnick, David


Pattie, Rt Hon Sir Geoffrey
Trippier, David


Peacock, Mrs Elizabeth
Twinn, Dr Ian


Porter, David (Waveney)
Vaughan, Sir Gerard


Portillo, Michael
Viggers, Peter


Powell, William (Corby)
Waldegrave, Rt Hon William


Price, Sir David
Walden, George


Raison, Rt Hon Sir Timothy
Walker, Bill (T'side North)


Rhodes James, Robert
Walker, Rt Hon P. (Wcester)


Riddick, Graham
Wallace, James


Rifkind, Rt Hon Malcolm
Walters, Sir Dennis


Roberts, Sir Wyn (Conwy)
Ward, John


Roe, Mrs Marion
Warren, Kenneth


Rumbold, Rt Hon Mrs Angela
Watts, John


Ryder, Rt Hon Richard
Wells, Bowen


Sainsbury, Hon Tim
Wheeler, Sir John


Sayeed, Jonathan
Whitney, Ray


Shaw, David (Dover)
Widdecombe, Ann


Shaw, Sir Giles (Pudsey)
Wiggin, Jerry


Shaw, Sir Michael (Scarb')
Wilkinson, John


Shelton, Sir William
Wilshire, David


Shephard, Mrs G. (Norfolk SW)
Winterton, Mrs Ann


Shepherd, Colin (Hereford)
Winterton, Nicholas


Shersby, Michael
Wolfson, Mark


Sims, Roger
Wood, Timothy


Skeet, Sir Trevor
Woodcock, Dr. Mike


Smith, Tim (Beaconsfield)
Yeo, Tim


Speed, Keith
Young, Sir George (Acton)


Speller, Tony
Younger, Rt Hon George


Spicer, Sir James (Dorset W)



Spicer, Michael (S Worcs)
Tellers for the Noes:


Squire, Robin
Mr. David Lightbown and


Stanley, Rt Hon Sir John
Mr. John M. Taylor.

Question accordingly negatived.

PUBLIC ACCOUNTS

Ordered,
That Mr. Graham Allen be discharged from the Committee of Public Accounts and Dr. Kim Howells be added to the Committee.—[Mr. Boswell.]

Dyslexic Children

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boswell.]

Mr. Peter Walker: The last time that I had the privilege of initiating an Adjournment debate was in 1961, when I enthusiastically advocated a bypass for the village ofa Ombersley in my constituency. I am delighted to say that, 15 years later, the bypass was built. I hope that the result of this debate will be rather more speedy and that it will be more effective in its approach to a serious problem.
I raise this subject because of an event in my constituency 10 or 15 years ago, when the 11 year-old son of a constituent who was quite well known to me was having enormous problems at school. He had been condemned for being careless and bad at spelling and English. He had constantly bad school reports, and anxious parents condemned the boy for his failure to apply himself properly to school work. Suddenly, on the advice of a friend, he was examined for the possibility of dyslexia, and it was discovered that he was a bad case. Having discovered that, the parents approached the education authority to try to tackle the problems involved. The authority could provide no proper education to meet the difficulties of the child.
The parents discovered that, in the private sector of education, there were schools that specialised and had the appropriate training. One of the best was a boarding school. The parents sold their house and lived in a caravan for six years so that they could send their child to an educational establishment where his handicap could be overcome. They succeeded. Their son achieved good A-levels and went to university. He is now following a good and successful career. He survived because of the immense sacrifice of his parents.
Because of that experience, I have always wanted much more to be done in that area. If one has the privilege of serving in the Cabinet, one cannot publicly campaign on issues that are not within one's departmental responsibility. I recall going to see my former colleague Sir Keith Joseph when he was Secretary of State for Education and Science. I outlined the details of the problem, the failure of the whole education system to recognise it, and the failure of the Department of Education and Science and of the education authorities either to identify the problem or to provide the appropriate education.
Being the kind and compassionate person that he was, Sir Keith listened with immense interest. I must confess that the observations of the officials who surrounded him rather frightened me. They suggested that many parents used dyslexia as an excuse for the bad performance of their children. There was a slight atmosphere of suspicion about whether the problem was of the order that I was suggesting and whether it was something that could be clearly identified and treated. I went away depressed, but Sir Keith decided to hold a symposium to examine the subject in depth. He kept to his word and held that symposium, but alas, a few weeks later, he left that office.
I do not believe that there has been anything like the progress required. What is the dimension of the problem? The most authoritative organisations believe that 340,000 children in our schools are suffering from dyslexia. That means one in every class. It means that in the typical

constituency, there are probably 550 children suffering from dyslexia, and so 1,000 parents are having to face all the difficulties involved.
Some time ago, I was given lunch by Sir Nicholas Lloyd, the editor of the Daily Express, and I persuaded him that it was a good area in which a national newspaper should campaign. He thought about the idea and decided to do it. The Daily Express fought a good campaign to try to arouse public interest in the topic. It is staggered by the correspondence that it has received, from all over the country, from parents and children who have suffered and whose problems have not been solved.
What is the basic requirement to tackle the problem? What are the areas in which the Government and education authorities can act? We start with the need for identification, and at an early age. The Government are now suggesting that the test for seven-year-olds may result in greater identification. I hasten to point out, as someone who has studied the matter in great depth, that it would be more appropriate if the problem could be identified even pre-school, if school starts at the age of five, or certainly in the first year at school. In New Zealand the condition is being identified in pre-school children and in children in the first year of school.
This brings me neatly on to the problem of teacher training, which in this country does not deal with the problem. I recently tabled a parliamentary question to the Department of Education and Science. The Minister who is kindly replying to this debate answered me with the magic words that teacher training colleges "should" provide tuition on the subject. He did not say that they would, or that they do. I know from my study of the subject that most teacher training colleges either spend no time at all or very little time on the topic. Teacher training colleges devote only 100 hours of training to literacy, and most of them devote none of that time to this problem.
We should see to it that every training college in the country trains teachers in how to identify and then tackle this problem. A vast section of the profession already practising has no training in this sphere, so we need courses for those already in education. Such courses exist, but I know that teachers find it difficult to be given time off and the necessary grants to attend them. Nothing like enough is being done.
Once the problem is identified, a typical authority should be able to issue a statement recognising that a child has a problem. A parent who believes that his child suffers from it applies to the authority. It takes many months in most authorities' areas before recognition follows.
Following recognition, what happens depends not on the needs of the child in question but on what facilities are available in an authority's area. Hardly any are available under most authorities; a few are available in some. A child with this condition, needs a certain type of tuition in order to overcome it, but authorities say that all they can do for the present is recognise the problem. The parent who knows what can and should be done sees that the private sector of education has the proper facilities—if he or she can afford the payments. Most cannot, so the problem goes untreated.
The education system must be made by statute to recognise the problem, and every education authority must then provide the required facilities. Such facilities have already been developed and shown themselves successful. They transform a child from a person who has great difficulty reading and spelling to someone who can


read normally—and probably spell normally, although there is a long transition period—and who can pursue any type of career.
These children are not, as is often suspected, mentally handicapped or retarded. They are often of higher than average ability. By our failure to tackle this problem, we are losing 340,000 children—one in every class in the land —whose careers will be blighted and who will not achieve the happiness and fulfilment that they should.
As a former Minister, I have dealt with many Adjournment debates, and I am sure that I will be told this evening that a great deal is being done. I know that the Minister is consulting a number of expert authorities on spelling, on exam problems and so on. But the Department and education authorities have been discussing and considering this matter for 20 years. Some, but in my judgment very little, progress has been made.
In this pre-election period, I hope that there will be a competition between the parties to promise most in this respect in their manifestos. There is no reason why Governments of either complexion cannot promise that every teacher training college will begin to teach new teachers how to identify dyslexia and provide the teaching to overcome it—and carry out that promise within the lifetime of a Parliament.
That Government should be able to ensure that every education authority has the facilities to provide that which is required to overcome the problem. They should be able to ensure that, at the age of five, every child is tested to ascertain whether there is such a problem and immediately to identify it. If a Government put their mind to the problem, in five years we could have the perfect system for dealing with dyslexia. We could have a system under which never again would children and parents go through ghastly anxiety, terrifying problems, colossal misery, feelings of failure and immense frustration, which are the result of a complete approach never having been brought to the problem.
I shall be delighted to hear all that is going on, but I want from any Administration that governs this country a determination that in a few years the problem will have been tackled. Aston university has 10,000 case studies. A department was established, and over 20 years it became the expert authority. It was then closed down. The department no longer exists, but the case studies remain to be examined. I speak of an area of neglect within which there has been much human misery and much lost opportunity for coming generations, and the problems should be tackled.

The Parliamentary Under-Secretary of State for Education and Science (Mr. Michael Fallon): I am sure that the House will wish me to congratulate my right hon. Friend the Member for Worcester (Mr. Walker) on his persistence over 30 years in articulating the problems of his constituents and on the service that he has rendered this evening in enabling us to discuss an issue on which he has spoken so knowledgeably and, if I may say so, so passionately.
It is no secret that some well-known public figures have suffered from dyslexia. For example, Susan Hampshire and Angharad Rees have overcome their difficulties

admirably to carve out successful acting careers. It may be less well known that some major historical figures are also believed to have suffered from the same condition. Such leaders in their fields as Hans Christian Andersen, Leonardo da Vinci, Auguste Rodin, Thomas Edison and Albert Einstein are reported to have suffered from dyslexia. I think that my right hon. Friend and I can agree that it is important that as many children as possible leaving school should have acceptable literacy skills. As Francis Bacon said nearly 400 years ago,
Reading maketh a full man. … and writing an exact man.
Our success as a nation depends upon our ability to communicate properly and effectively more than ever before.
It is remarkable that in the face of all the evidence, including the facts that my right hon. Friend the Member for Worcester and the Daily Express have brought before us, there are some who do not accept the existence of dyslexia. I assure my right hon. Friend that I do, as does my Department. Some confusion arises from the different definitions that seem to abound. Dyslexia is in reality an old term which is today used in different ways, perhaps to the extent that the current understanding of the term has supplanted the original meaning. For some years, as my right hon. Friend implied, my Department scrupulously avoided using the word, and used instead the longer and more deliberate term "specific learning difficulties". Some local education authorities still do that as a firm matter of principle.
In any event, dyslexia is now generally taken by most in the field to be difficulty in learning to read or handle numbers, despite general intelligence at least within the normal range, a generally supportive environment and freedom from sensory disabilities of vision or hearing that could account for the difficulty. Whatever the learning difficulty is called, any child with such problems will have difficulties in environments that are book based or in those in which, for example, the decoding of road signs, maps or instructions of any sort are practical necessities.
Schools and society properly value those who acquire a good standard of literacy skills, but it is precisely those skills which dyslexic people find so difficult to master. Thankfully, most professionals and authorities involved today have a more responsible attitude towards helping such children. I am glad to say that we are now a long way from the bad old days when dyslexic children were destructively labelled as stupid or plain bone idle.
I shall mention three specific points that my right hon. Friend raised—teacher training, provision for dyslexic children and methods of reading. I shall deal first with teacher training. Specific training is now available for serving teachers of pupils with dyslexia. The training of teachers of pupils with special educational needs in ordinary schools and training to meet the special educational needs of students in further education with learning difficulties have both been priority areas supported by the Department through the local education authority training grants scheme since it came into operation in 1987. The Department has also sponsored the production of an audio-visual pack designed to assist teachers in ordinary schools to identify children with special educational needs. One module of this is specifically concerned with dyslexia.
My right hon. Friend is specifically concerned with courses of initial teacher training. They are now required


to equip prospective teachers to teach the full range of pupils that they are likely to encounter in an ordinary school and to introduce them to ways of identifying children with special educational needs, including dyslexia. However, while we aim to ensure that all teachers receive a general introduction to dyslexia and other learning difficulties during their initial training, further specialist training is best reserved for experienced teachers.
That said, we have shared the widespread public concern about the teaching of reading generally. Last week my right hon. and learned Friend the Secretary of State asked the Council for the Accreditation of Teacher Education to undertake an inquiry into the preparation of student primary teachers to teach reading. Dyslexia is one small part of the literacy issue. CATE does not have a remit to look into special educational needs in particular, but it has been asked to carry out a full inquiry into the training of teachers to teach reading, and to provide advice on the criteria that we apply in accrediting teacher training courses and the guidance that we give to institutions on the matter.
In view of what my right hon. Friend said, it would be right for that inquiry to reflect what has been said tonight. I shall refer the debate to CATE. We look forward to practical and sensible advice on the subject from the council by the end of the year.
There is currently a debate about precisely which methods of teaching are best for children with dyslexia. It is for local education authorities to develop an appropriate framework for provision and for the teachers on the spot to decide on and to use the methods appropriate for the individual children in their class. My right hon. and learned Friend the Secretary of State made that point the other day, when he told the Select Committee that he did not care which methods were used as long as they produced the result. But of course that proviso is all important. It is the result that counts.
Each method has its own approach and requirements of children. It is clear, for example, that the look and say method—the famous Janet and John books—which assumes that children learn best by recognising the shape of words rather than having them broken down into individual sounds, requires certain abilities and memory functions on the part of the child. Obviously that will not be suitable for all children, although it has its place. Much has also been said in the media about the "real books" approach, which relies on the attractions of books written primarily for their stories rather than on accommodating any particular reading technique. This method assumes that children are motivated best by understanding the meaning of what they read and must find it fun. It was revealing to hear of a teacher the other day insisting instead that this should be called the "good books" approach. Trollope would probably have agreed. He is supposed to have said:
Of all the needs a book has the chief need is that it be readable.
However, I wonder whether Lewis Carroll's Alice was taught to read by the real books method in an educational Wonderland, as I recall her saying
What is the use of a book … without pictures".
This approach, used in conjunction with other methods, may be suitable for some able children with no impediments to their learning. However, I have my doubts. Children may be eager and ready to learn. They may enjoy hearing stories and browsing through picture

books. But they do not teach themselves. They cannot learn to read without skilled teaching. It is a wrong-headed fallacy of our times that the role of the teacher should or can be passive—that she or he should support, approve and encourage but never explain, instruct, question or correct, as preached by some disciples of "real books". Luckily, there are not many of them. Her Majesty's inspectorate found only a very small number of schools concentrating exclusively on "real books". I am reassured to some extent by that, because, first and foremost, as I said, reading must be taught. It cannot be picked up by osmosis.
The phonic method, which needs to he taught in that sense and requires children to memorise different consonant and vowel sounds and to break words down into their individual components, has many merits. There is, of course, the need later on to cater for the innumerable exceptions in our language and each child's degree of phonic readiness needs to be assessed individually. I believe that the phonic method has much to commend it, and it is a very appropriate element for some children with learning difficulties. But even in cases where a phonic approach can bring success, teaching should not sensibly be based on that method alone.
The main message from HMI is that no one method should be cherished as the holy grail to be pursued by all. The recent HMI report on "The Teaching and Learning of Reading in Primary Schools" found that the most effective teachers used a mix of methods to teach reading and that their teaching was carefully planned and structured. However, they invariably included phonics alongside other methods. An exclusive concentration on any one method of teaching reading, whether it was "real books" or phonics, was associated with higher levels of failure among pupils. I know, too, that the multi-sensory approach, which employs visual and auditory methods reinforced by tactile devices, has been preferred by many teachers of dyslexic children for some years. It has clearly had its successes, too. Whichever methods are adopted, it is important that the ethos of the whole school is flexible, positive and encouraging.
I turn to provision, which I suspect most interests my right hon. Friend. As he stressed, early identification of the signs of dyslexia is important. It is no good finding out that a child has dyslexia at the age of 14. However, it is open to some doubt whether LEAs would be able to pick up literacy problems—let alone dyslexia—at or before the age of six. I hold this view because reading and writing are not generally taught systematically to a sufficiently high level at that point for deficiencies, unless marked, to become obvious or testable. It is both the blessing and the curse of dyslexia that it is not as obvious to the beholder as, say, a physical disability.
As soon as learning difficulties are identified, however, schools and education authorities have a legal obligation to take action. Schools will often be able to make suitable provision from within their own resources. Where they cannot, LEAs must make an assessment and draw up a statement where appropriate.
The duties of all governors, schools and LEAs towards pupils with special educational needs are spelt out quite clearly in the Education Act 1981. It is for local education authorities and school governors to identify children who have, or may have, special educational needs, including those with dyslexia. In county and voluntary schools, governors must use their best endeavours to secure that the


required provision is made for pupils with special educational needs. They must also make sure that teachers in the schools are aware of the importance of identifying, and providing for, any of their registered pupils who have special educational needs.
What has come to be called a "whole school approach" is necessary for children's special educational needs to be met effectively. For schools to meet the challenges before them, it is crucial that clear and coherent policies be set in place at the different class, school and LEA levels. Such policies should cover all aspects of SEN provision and should be based on a realistic assessment of the current costs of provision. They should also set out direct plans of action and indicate the duties and responsibilities of all involved in the service. Effective monitoring and evaluation of these plans is essential to their success.
When LEAs make assessments or draw up statements of SEN under the Education Act 1981 they must take educational, medical and psychological advice. If a statement is drawn up, it must stipulate clearly the provision, in terms of human or material resources, which is required to support the child and to give access to as near to a full curriculum as possible. Once a statement is prepared—I accept my right hon. Friend's point that there may have been too much delay in the preparation of such statements—the LEA is obliged to meet the provision specified.
Under the same Act, a parent has the right to ask the local education authority to carry out an assessment of his child's needs. The authority must comply with that request unless it is, in its opinion, unreasonable.
The process of drawing up a formal statement necessarily takes some time. However, parents are right not to accept sluggishness if it occurs in these cases and right, too, to press for faster action by authorities if they are not satisfied with the way that the process is being handled. My Department recommends that the whole process, from initial notification to the drawing up of a draft statement where necessary, should normally take no longer than six months.
My right hon. Friend might like to know that about two thirds of the appeals to the Secretary of State against an LEA failing to make a statement, or against the content of a statement, concern dyslexia.
It is not for my Department to make provision, but clearly Ministers have a responsibility for what is taking place. I do not treat that responsibility for oversight lightly. Indeed, the Department has taken its interest so far

as to fund some substantial research projects in the past and now. The Department funded four research projects 10 years ago and we are currently funding a total of £250,000 over three academic years to support the work of the dyslexia centre of the Harris city technology college. It is the intention of the Harris CTC Trust that the approach of the dyslexia centre in the CTC should be innovative, particularly in relation to the use of information technology in approaching this work. The results will be widely disseminated and should achieve national significance.
I should like to say a word or two about the proposed spelling penalty of up to 5 per cent. in GCSE examinations. My right hon. and learned Friend the Secretary of State wrote to the Schools Examinations and Assessment Council suggesting this in January. In its reply, SEAC said that it has agreed with the examining groups that for 1991 all candidates will be warned that they
are expected to use good English".
SEAC has also undertaken to initiate further work with examining bodies about additional steps that can be taken for 1992 and subsequent years and to report again to the Secretary of State in July and December.
When my right hon. and learned Friend wrote to SEAC earlier this month accepting those proposals, he made it clear that he would look to SEAC to be more specific in its further reports on the way in which marking schemes should take account of bad spelling, on the use of computer spell checks and on the possible need for changes in the arrangements for ensuring that handicapped candidates can compete on an equal basis with their peers.
I hope that my right hon. Friend is persuaded of my interest in and commitment to this hugely important area. Like him, I regard it as essential that we put an end to linguistic discrimination, and consign the lexical bar to the past. The issues of race and sex discrimination are serious and well known to the House, but discrimination against any person because he cannot read, express himself clearly, be understood or understand his own language is just as subtle and hidden a form of discrimination, and just as pernicious for that. It is, therefore, crucial that as many of our children as possible leave school functionally literate, and I am confident that the structures are in place to achieve just that.
A debate such as this serves to remind us that we must pursue that target with more vigour than we have in the past.

Question put and agreed to.

Adjourned accordingly at thirteen minutes past Twelve o'clock.